P0437 - Colonic Perforation in a Patient on GLP-1 Agonist Therapy: A Case Report

Mohammed I. Khan, DO, DPT¹, Shuchita Jhaveri, MD, MPH², Bhavin Patel, MD², John Paek, DO², Ahmed Ouni, MD², Bilal Ashraf, MD², Sivatej Sarva, MD²
1HCA Healthcare Kingwood Hospital/University of Houston, Missouri City, TX; 2HCA Healthcare Kingwood Hospital/University of Houston, Kingwood, TX

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 female 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 two 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.

Disclosures:
Mohammed Khan indicated no relevant financial relationships.
Shuchita Jhaveri indicated no relevant financial relationships.
Bhavin Patel indicated no relevant financial relationships.
John Paek indicated no relevant financial relationships.
Ahmed Ouni indicated no relevant financial relationships.
Bilal Ashraf indicated no relevant financial relationships.
Sivatej Sarva indicated no relevant financial relationships.

Mohammed I. Khan, DO, DPT¹, Shuchita Jhaveri, MD, MPH², Bhavin Patel, MD², John Paek, DO², Ahmed Ouni, MD², Bilal Ashraf, MD², Sivatej Sarva, MD². P0437 - Colonic Perforation in a Patient on GLP-1 Agonist Therapy: A Case Report, ACG 2025 Annual Scientific Meeting Abstracts. Phoenix, AZ: American College of Gastroenterology.