Cannabis and Delayed Diagnosis of Neglected Peritonitis: A Case Report

Background: Acute appendicitis is the leading cause of surgical abdominal emergency in young patients. However, chronic cannabis use may alter pain perception and mask the severity of clinical presentation. We report the case of a young patient with misleading clinical signs despite generalized peritonitis. Case presentation: A 19-year-old male, chronic heavy smoker and cannabis user, was initially admitted for mild abdominal pain. After a first emergency visit, he was discharged home. One week later, he was readmitted with the same complaints. Laboratory tests revealed leukocytosis (19,000), elevated CRP (259 mg/L), renal failure, hypokalemia, and hyponatremia. CT scan showed massive intra-abdominal effusion and a borderline appendix (7 mm). Exploratory laparotomy revealed 3 liters of pus, false membranes, interloop abscesses, and both a perforated appendix and perforated Meckel’s diverticulum. An extended ileocecal resection with double stoma and abdominal drainage was performed. Postoperative recovery required intensive care unit (ICU) admission with a favorable outcome. Conclusion: Cannabis use may attenuate abdominal symptoms, delaying diagnosis and management of surgical emergencies. This case highlights the importance of detailed toxicological history in young patients.