Tirzepatide-Induced Functional Small Bowel Obstruction in a Surgically Naïve Patient: A Case Report

Area of Science:

• Gastroenterology
• Pharmacology

Background:

• Tirzepatide is a dual glucose-dependent insulinotropic polypeptide (GIP) and glucagon-like peptide-1 (GLP-1) receptor agonist used for type 2 diabetes and obesity.
• Gastrointestinal side effects are common with GLP-1 receptor agonists, but functional small bowel obstruction is an underrecognized complication.

Purpose of the Study:

• To describe the potential for Tirzepatide dose escalation to cause functional small bowel obstruction (FSBO).
• To highlight diagnostic strategies and non-operative management for FSBO in patients treated with Tirzepatide.

Main Methods:

• Retrospective case review of patients presenting with symptoms suggestive of small bowel obstruction.
• Detailed medication history, including Tirzepatide dosage and escalation.
• Utilization of water-soluble contrast studies to differentiate functional from mechanical obstruction.

Main Results:

• Tirzepatide dose escalation was associated with the onset of FSBO in several patients, including those without prior abdominal surgery.
• Symptoms included abdominal pain, distension, nausea, and vomiting, mimicking mechanical small bowel obstruction.
• Water-soluble contrast challenge demonstrated characteristic findings of FSBO, guiding conservative management.

Conclusions:

• Tirzepatide dose escalation can precipitate FSBO that clinically resembles mechanical obstruction.
• Thorough medication review and objective diagnostic tools like the water-soluble contrast challenge are crucial.
• These measures facilitate safe non-operative management and help avoid unnecessary surgical interventions.