S6105 Small Bowel Obstruction Associated With Semaglutide Use

Introduction: Glucagon-like peptide-1 receptor agonists are United States Food and Drug Administration-approved medications initially developed for type 2 diabetes but have recently gained popularity due to their weight loss benefits. While beneficial for weight management delayed gastric emptying can lead to gastrointestinal adverse effects including nausea, vomiting, constipation, gastroparesis and rarely small bowel obstruction. Given the increasing popularity of glucagon-like peptide-1 (GLP-1) agonists; how can clinicians better identify patients at increased risk for severe gastrointestinal complications such as small bowel obstruction? Case Description/Methods: A 66-year-old woman with a medical history significant for obesity presented to the emergency department with a 2-day history of abdominal pain and absence of flatus or bowel movements. Two months ago she was initiated on treatment with semaglutide for weight loss. Her surgical history includes a hysterectomy. Despite NG tube decompression she continued to have a surgical abdomen. Exploratory laparotomy revealed congested bowel with early ischemic changes necessitating a 10 cm small bowel resection. Approximately 1 year later while still using semaglutide she presented again with abdominal pain. Exploratory laparotomy was performed revealing extensive adhesions requiring lysis and additional small bowel resection with anastomosis. Following the second surgical intervention discontinuation of semaglutide was recommended by her general surgeon as a likely etiology behind her recurrent small bowel obstruction. Discussion: GLP-1 receptor agonists have been associated with bowel obstruction at rates approximately 4.5 times higher than other antidiabetic medications. This case underscores the importance of recognizing bowel obstruction as a potentially significant adverse effect of GLP-1 receptor agonists. Clinicians should maintain vigilance when initiating and continuing GLP medications especially in patients with prior abdominal surgeries.