First reported case of superior mesenteric artery syndrome caused by weight loss from cannabinoid hyperemesis | Research

The takeaway

A 17-year-old with cannabinoid hyperemesis syndrome developed superior mesenteric artery syndrome (a rare bowel obstruction) after rapid weight loss from chronic vomiting, marking the first reported case linking these two conditions.

Emergency physicians, gastroenterologists, and clinicians treating patients with cannabinoid hyperemesis syndrome.

First reported case linking CHS weight loss to SMA syndrome

What the researchers found

A 17-year-old with a history of heavy cannabis use and recurrent nausea/vomiting meeting criteria for cannabinoid hyperemesis syndrome presented with sudden severe bilious vomiting. CT imaging revealed superior mesenteric artery syndrome, a duodenal obstruction caused by rapid weight loss reducing the protective fat pad between the SMA and aorta.

Why it matters

This is the first documented case of SMA syndrome resulting from CHS, alerting clinicians to a potentially dangerous complication when chronic cannabis-related vomiting causes significant weight loss.

The numbers in context

Patient was 17 years old. Maintained a normal BMI despite rapid weight loss. Chronic heavy cannabis use with symptoms meeting Rome IV criteria for CHS.

How the study worked

Single case report of a 17-year-old adolescent presenting to the emergency department with voluminous bilious emesis, chronic heavy cannabis use, and a history of weight loss.

What this study cannot tell us

Single case report. Cannot establish how common this complication is. Limited details on the patient's treatment and outcome. No information on long-term follow-up.

How to read the evidence

Single case report. Establishes a possible association but cannot determine frequency or causation.

When this study was published

Published in 2022.

The bigger picture

As cannabinoid hyperemesis syndrome becomes more commonly recognized, this case demonstrates that the persistent vomiting and weight loss associated with CHS can cascade into additional serious medical complications beyond the syndrome itself.

Questions still open

How often does significant weight loss occur in CHS patients? Should clinicians screen for SMA syndrome when CHS patients present with sudden symptom escalation? Does the complication resolve with cannabis cessation?

Common questions

What is cannabinoid hyperemesis syndrome?

CHS is a condition in chronic heavy cannabis users characterized by recurrent episodes of severe nausea, vomiting, and sometimes abdominal pain. Symptoms typically resolve with cessation of cannabis use.

What is superior mesenteric artery syndrome?

SMA syndrome occurs when the third part of the duodenum (small intestine) gets compressed between the superior mesenteric artery and the aorta, usually after significant weight loss reduces the protective fat cushion between these vessels, causing bowel obstruction.

Read the original research

Case Report: Superior Mesenteric Artery Syndrome in an Adolescent With Cannabinoid Hyperemesis.

Frontiers in pediatrics, 10, 830280

View on PubMed ↗Publisher’s paper ↗

Citation

Berken, Jonathan A; Saul, Samantha; Osgood, Peter T. (2022). Case Report: Superior Mesenteric Artery Syndrome in an Adolescent With Cannabinoid Hyperemesis.. Frontiers in pediatrics, 10, 830280. https://doi.org/10.3389/fped.2022.830280