A 16-Year-Old Who Used Synthetic Cannabis for 3 Years Developed a Perforated Duodenal Ulcer | Research

The takeaway

A case report described a 16-year-old boy who developed a perforated duodenal ulcer after 3 years of regular synthetic cannabinoid ("bonsai") use, requiring emergency surgery.

Emergency clinicians and parents concerned about the gastrointestinal effects of synthetic cannabinoids.

3 years of synthetic cannabinoid use preceded life-threatening duodenal perforation

What the researchers found

This case report described a 16-year-old male who presented to the emergency department with abdominal distension, pain, and bilious vomiting. He had been regularly using synthetic cannabinoids ("bonsai") for 3 years.

Imaging revealed free air under the diaphragm, indicating perforation. Emergency surgery (laparotomy) found a perforation in the first part of the duodenum. Surgical repair with an omental patch (Graham patch) was successful, and the patient recovered without complications.

The authors attributed the peptic ulcer disease and perforation to the chronic effects of synthetic cannabinoids on gastric secretion and gastric emptying, noting that this is a rarely recognized complication.

Why it matters

Gastrointestinal perforation is a life-threatening complication that is not typically associated with substance use in adolescents. This case highlights that chronic synthetic cannabinoid use can produce serious gastrointestinal complications beyond the better-known CHS.

The numbers in context

Patient age: 16. Duration of synthetic cannabinoid use: 3 years. Perforation location: first part of duodenum. Repair: Graham patch. Outcome: uncomplicated recovery.

How the study worked

Single case report with clinical description, imaging findings, surgical intervention, and postoperative follow-up.

What this study cannot tell us

A single case report cannot establish a causal relationship between synthetic cannabinoid use and duodenal perforation. The patient may have had other risk factors for peptic ulcer disease. The specific synthetic cannabinoid compounds used were not identified.

How to read the evidence

This is a single case report providing anecdotal evidence of a possible association between synthetic cannabinoid use and gastrointestinal perforation.

When this study was published

Published in 2016. Awareness of synthetic cannabinoid gastrointestinal effects has grown since then.

The bigger picture

This case adds gastrointestinal perforation to the growing list of serious adverse effects from chronic synthetic cannabinoid use. Emergency clinicians encountering unexplained peptic ulcer disease in adolescents should consider substance use, particularly synthetic cannabinoids, as a possible contributing factor.

Questions still open

How common are gastrointestinal complications from chronic synthetic cannabinoid use? Do natural cannabis products carry the same gastrointestinal risk?

Common questions

Can synthetic cannabis cause stomach problems?

Synthetic cannabinoids can affect gastric acid secretion and gastric emptying. This case report describes a severe complication (duodenal perforation), though this appears to be rare. More common gastrointestinal effects of synthetic cannabinoids include nausea and vomiting.

Is this the same risk with natural cannabis?

This case involved synthetic cannabinoids, which are much more potent than natural cannabis. While cannabis can cause gastrointestinal effects (including hyperemesis syndrome), the specific complication of duodenal perforation has not been commonly associated with natural cannabis use.

Read the original research

Unusual side effect of cannabis use: acute abdomen due to duodenal perforation.

International journal of emergency medicine, 9(1), 18

View on PubMed ↗Publisher’s paper ↗

Citation

Buyukbese Sarsu, Sevgi. (2016). Unusual side effect of cannabis use: acute abdomen due to duodenal perforation.. International journal of emergency medicine, 9(1), 18. https://doi.org/10.1186/s12245-016-0114-7