Non-prescription cannabis use for symptom management amongst women with gynecologic malignancies.

OBJECTIVES: To evaluate interest in and patterns of use of non-prescription cannabis products for symptom management amongst gynecologic cancer patients living in states with legal access to medical and recreational marijuana. METHODS: Cross-sectional study using a novel 35-question survey distributed to women diagnosed with gynecologic cancer within two academic centers in California and Colorado. The survey queries demographic and disease traits, and both objective and subjective issues surrounding use of cannabis products for symptom management. Surveys were distributed to patients actively receiving treatment or under surveillance. RESULTS: Enrollment began July 16, 2018 and was completed December 1, 2018. Survey return rate was 52.7%. A total of 225 participants met inclusion criteria.Sixty-two percent reported that they have used or would be interested in using cannabis products for symptom management; 60 (26.7%) are using non-prescription cannabis for treatment of cancer related symptoms, and 80 (35.6%) are interested in using cannabis derivatives under direction of their oncologist. Reasons cited for use of cannabis included: pain control (n = 41, 68.3), insomnia (n = 33, 55.0%), anxiety (n = 29, 48.3%), nausea (n = 26, 43.3%), and appetite stimulation (n = 21, 35.0%). Of the women using cannabis products, almost half report decreased prescription narcotic use after initiation of cannabis products (n = 27, 45.0%). CONCLUSIONS: Women with gynecologic cancer report a strong interest in the use of non-prescription cannabis products for management of cancer-related symptoms. Practitioners in the field of gynecologic oncology should be aware of the frequency of use of non-prescription cannabis amongst their patients as well as the growing desire for guidance about the use of cannabis derivatives. A substantial number of patients report decreased reliance on opioids when using cannabis derivatives for pain control.

Obscure Overt Gastrointestinal Bleeding Secondary to Ventral Hernioplasty Mesh Small Bowel Perforation Visualized With Video Capsule Endoscopy.

We report a case of a 79-year-old female presenting with hematemesis and melena 9 years after ventral hernioplasty with mesh. After initial normal endoscopy and colonoscopy, video capsule endoscopy revealed a metallic wire mesh perforating the jejunum. Abdominal computed tomography did not identify a perforation although metallic mesh was visualized close to the small bowel. We present the first ventral hernia mesh perforation diagnosed via video capsule endoscopy. Such a finding emphasizes the importance of a complete diagnostic workup when approaching a patient with obscure overt gastrointestinal bleeding.