Triple Air Leak Syndrome in Cannabinoid Hyperemesis: A Diagnostic Challenge Managed Conservatively

Cannabinoid hyperemesis syndrome (CHS) is a condition marked by recurrent nausea, vomiting, and abdominal pain in chronic cannabis users. Rarely, severe vomiting can lead to complications such as spontaneous pneumomediastinum, pneumopericardium, and pneumoretroperitoneum. We present a case of a 21-year-old woman with CHS who developed a rare triad of spontaneous pneumomediastinum, pneumopericardium, and pneumoretroperitoneum. Initial findings raised concern for Boerhaave syndrome; however, imaging ruled out esophageal perforation. The patient was managed conservatively with bowel rest, intravenous fluids, electrolyte correction, antiemetics, and antibiotics, resulting in full recovery. This case highlights the diagnostic challenges in distinguishing CHS common nonserious complications from more serious conditions and underscores the importance of prompt imaging. It also emphasizes the need for increased awareness of rare air leak syndromes in CHS and further research into their pathophysiology and optimal management.