USE OF GLP-1 ANALOGUE AS A CAUSE OF COMPLICATED ACUTE OBSTRUCTIVE ABDOMEN WITH PERFORATION – CASE REPORT AND LITERATURE REVIEW

Case Presentation A 38-year-old female patient with Myasthenia Gravis, using Azathioprine and injectable Semaglutide, was admitted to the emergency unit with abdominal pain, distension, and diarrhea. She had leukocytosis without deviation and no other signs of inflammatory response. Fecal calprotectin, fecal leukocytes, and rotavirus tests were negative. An abdominal CT scan revealed wall thickening in the left colon, with adjacent fat densification and liquid layers in between, suggesting colitis. Antibiotic therapy was initiated, but on the second day of hospitalization, the patient showed worsening abdominal pain and distension, with peritoneal irritation, though without hemodynamic repercussions or laboratory worsening. A rectosigmoidoscopy showed no alterations and was stopped at 25 cm from the anal margin due to the presence of rock-like stool. On the third day of hospitalization, the abdominal pain and distension did not improve, and a new abdominal CT scan revealed pneumoperitoneum and stool outside the loop, adjacent to the colprostasis seen in the previous examination. The patient underwent exploratory laparotomy, which identified a perforation in the sigmoid colon measuring about 2 cm, with necrotic edges. A Hartmann’s procedure was performed with rectosigmoidectomy. The pathological anatomy showed wall necrosis, abscess in the subserosa, acute fibrinoleukocytic peritonitis, and hypertrophy of the muscularis propria.

Discussion Patients with Myasthenia Gravis can present with intestinal dysmotility; however, what stands out in this case is that the onset of the obstructive condition occurred after the use of Semaglutide. The mechanism of action of GLP-1 receptor analogs involves decreased gastrointestinal motility. Literature describes an increased risk of intestinal obstruction among both diabetic and non-diabetic patients using these drugs.

Conclusion Identifying risk factors for intestinal obstruction among patients who are candidates for GLP-1 receptor analog therapy and contraindicating the use in such cases could help prevent serious adverse effects related to this drug class. However, current data indicate that even among previously healthy individuals, there is an increased risk of various gastrointestinal complications. With the recent increase in Semaglutide and other GLP-1 analog prescriptions, adverse effects have been reported more frequently than expected. Long-term studies are necessary to identify potentially severe complications related to these drugs.

 

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No conflict of interest has been declared by the author(s).

Publication History

Article published online:
25 April 2025