Small bowel intussusception in marijuana users

Abstract

Intussusception occurs when one portion of bowel ‘telescopes’ into another due to a lead point created by a range of benign or pathologic process. Intussusception mostly occurs in children. Although adult intussusception (AI) is rare, accounting for <5% of intestinal obstructions, it is more concerning in adults as malignancy accounts for nearly 65% of lead points in AI. Patients present with severe abdominal pain concerning for an acute abdomen along with a degree of bowel obstruction. We have experienced a total of 11 patients within recent years presenting with symptoms of an acute abdomen due to AI. None of these patients were found to have a pathologic process creating a lead point. However, we found that all of them were marijuana users. In this report, we compare their management, hospital course and review of the literature discussing proposed mechanisms that suggest an association between cannabis and intussusception.

Adult Intussusception in Chronic Marijuana Users

“…Fernandez-Atutxa et al [9] first reported detailed a case series of chronic marijuana users who presented with intussusception. Since then, multiple published cases have supported a possible link between marijuana usage and AI [1,[5][6][7][8]. Causation between chronic marijuana use and intussusception has not been demonstrated, so most cases are identified after excluding other potential etiologies.…”

“…On review of the literature, 18 cases of AI in chronic marijuana users have been reported (Table 1) [1,[5][6][7][8][9]. All patients presented with non-specific symptoms like abdominal pain, nausea, vomiting, and diarrhea.…”

“…The studies have shown anti-peristaltic effects of cannabinoids through activation of cannabinoid receptor type 1 (CB1) receptors involving epithelial cells of the gastrointestinal (GI) tract and myenteric and submucosal nerve plexus [7]. There are several reported cases of AI in association with chronic marijuana use in the literature [1,[5][6][7][8][9]. We present four patients with history of chronic marijuana use who presented with intussusception.…”

“…The cannabinoids have anti-inflammatory effects and have shown a beneficial role in treating chemotherapy-related nausea and vomiting, multiple sclerosis (MS)-related spasticity and chronic pain [4]. The studies have shown anti-peristaltic effects of cannabinoids through activation of cannabinoid receptor type 1 (CB1) receptors involving epithelial cells of the gastrointestinal (GI) tract and myenteric and submucosal nerve plexus [7]. There are several reported cases of AI in association with chronic marijuana use in the literature [1,[5][6][7][8][9].…”

The Enteric Glia and Its Modulation by the Endocannabinoid System, a New Target for Cannabinoid-Based Nutraceuticals?

“…The components of the ECS are found in many cell types within the GI tract, including the ENS. Not surprisingly, exogenously administered cannabinoids have profound effects that may be beneficial for the treatment of some GI conditions [ 14 , 17 , 18 , 19 ], and adverse GI effects of their use have also been recognized (i.e., cannabinoid hyperemesis [ 20 , 21 ] and small bowel intussusception, [ 22 ]). However, the relationship between the components of the ECS and EGCs and the mechanism by which nutraceuticals may act through them have not been well established yet.…”