S3783 Colonic Perforation in a Patient on GLP-1 Agonist Therapy: A Case Report

Introduction: Glucagon-like peptide-1 (GLP-1) agonists are widely used for diabetes and obesity, with known gastrointestinal side effects (e.g., gastroparesis, ileus). However, bowel perforation—a rare but life-threatening complication—has limited documentation in the literature. This case highlights the potential severity of motility-related adverse events in a patient on GLP-1 therapy. Case Description/Methods: A 63-year-old woman with diverticulosis and diabetes (on GLP-1 therapy) presented with a 2-week history of nausea, vomiting, and constipation. Computed tomography (CT) revealed hard stool with diffuse liquid stool, prompting bowel regimens and NG decompression. Despite interventions, she developed hypotension and lactic acidosis (6.7). Repeat CT showed free air, and exploratory laparotomy confirmed colonic perforation, requiring Hartmann’s procedure and critical care. Discussion: While GLP-1 agonists are generally safe, this case underscores 2 critical lessons: 1. Severe motility dysfunction can progress to perforation, even without mechanical obstruction. 2. Delayed recognition is a risk—constipation in GLP-1 users warrants aggressive evaluation (e.g., early imaging, surgical consultation). This rare complication suggests the need for heightened vigilance for bowel perforation in patients on GLP-1 therapy with prolonged nausea/vomiting, multidisciplinary coordination among specialties/subspecialties for high-risk patients, and patient education on alarming symptoms.