SUN-727 - Small Bowel Obstruction Associated with Semaglutide (Ozempic): A Case Series

Background: Semaglutide (Ozempic), a glucagon-like peptide-1 receptor agonist (GLP-1 RA), has been increasingly utilized in the management of type 2 diabetes mellitus and obesity. While gastrointestinal adverse effects such as nausea, vomiting, and delayed gastric emptying are well described, data on severe gastrointestinal motility complications, including small bowel obstruction (SBO), are sparse.

Method: We describe a case series of three patients who developed small bowel obstruction potentially associated with Semaglutide use. Clinical characteristics, including presenting symptoms, recent dose escalation and duration of semaglutide therapy, imaging findings, management strategies, and clinical outcomes were reviewed. Potential alternative etiologies for SBO were also evaluated, including prior abdominal surgery, history of SBO, presence of hernias, concomitant medications associated with constipation, and electrolyte abnormalities at presentation.

Results: We included three patients with diabetes mellitus (ages 48, 72, and 79 years; two males, one female) who were receiving Semaglutide prior to admission presented with nausea, vomiting, abdominal pain, distention, and constipation and were diagnosed with SBO. Duration of semaglutide therapy ranged from 2 weeks to 8 months; two patients had undergone dose escalation to 1 mg weekly for 2–8 months, while one patient was receiving 0.25 mg weekly. One patient had a ventral abdominal wall hernia, while the other two had small bowel obstruction without an identifiable mechanical obstruction on CT imaging. No patient had a prior history of SBO, constipation-inducing medications, or electrolyte abnormalities. One patient with a midline ventral hernia required surgical intervention, while two were managed conservatively. Semaglutide was discontinued in all cases.

Conclusion: This case series suggests a potential association between semaglutide use and small bowel obstruction, possibly related to marked gastrointestinal motility slowing. Clinicians should consider severe motility-related complications in patients on GLP-1 receptor agonists presenting with obstructive gastrointestinal symptoms, particularly in the setting of recent dose escalation. Further studies are needed to define risk factors and underlying mechanisms.

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