SAT675 GLP-1RA Therapy And Intussusception: A Case Report Of Bowel Telescoping In Anobese Patient After Successful Weight Loss On Therapy
Authors: Alqaisi Sura , Doerfler William R , Latif Tariq , Bandi Archana 
Published: October 2023

Abstract
Disclosure: S. Alqaisi: None. W.R. Doerfler: None. T. Latif: None. A. Bandi: None.
Background: Glucagon-like peptide receptor agonists (GLP-1RA) are incretin-based drugs that are now a mainstay in managing type 2 diabetes and obesity, offering added cardiorenal benefits. GLP-1RAs slow gastric emptying and small bowel motility, leading to side effects like constipation, nausea, and diarrhea. Small bowel obstruction (SBO), though not well described in clinical trials, has been reported in observational studies. SBO due to intussusception is a rare condition in adults where one segment of the bowel telescopes into the adjacent segment, potentially causing intestinal ischemia. Although GLP-1RA therapy has not been previously linked to intussusception, we present a patient who developed intussusception while on GLP-1RA therapy for obesity. Case: A 54-year-old female with a history of prediabetes, generalized anxiety disorder, diverticulosis, and total hysterectomy with bilateral salpingo-oophorectomy who was referred for obesity class-I (BMI-33) management considered constitutional given the negative work-up. After an initial weight loss of 40 Ibs with diet and exercise, her success stalled. She was started on medical therapy, initially on orlistat which caused diarrhea, then switched briefly to phentermine-topiramate, that resulted in palpitations and increased anxiety. Hence, liraglutide was initiated, resulting in a further weight loss of 25 Ibs. Three months later, she admitted with left lower quadrant abdominal pain, nausea, vomiting, and diarrhea. Lab tests were unremarkable, and an abdominal CT scan showed an 8.9 cm segment of small bowel intussusception without obstruction. Her symptoms improved after a large episode of emesis and placement of a nasogastric tube. She underwent diagnostic laparoscopy followed by exploratory laparotomy. The entire small bowel length was examined, with no abnormalities found, indicating a transient intussusception. She was discharged on liraglutide. Later, she underwent a follow-up small bowel follow-through that showed normal small bowel features. Liraglutide therapy was discontinued, and she remains symptoms free. Discussion: This case highlights the importance of providers being aware of potential adverse effects, including the rare but serious complication of SBO in patients receiving GLP-1RA therapy. Significant weight and omental fat loss may have led to intussusception in our patient. Thinning of the mesentery and loss of visceral fat oppose less resistance to abdominal peristalsis, increasing the risk of intussusception. While the exact mechanism of GLP-1RA-induced SBO remains unclear, it is postulated that inhibition of intestinal motility may play a role, particularly in patients with pre-existing gastrointestinal neuropathy. Therefore, clinicians should monitor patients for signs of gastrointestinal distress or obstruction and investigate suspected cases promptly for timely management.
Presentation: Saturday, June 17, 2023