SHM Converge Scientific Abstract ePoster Gallery-A Case of Ischemic Colitis in a 39 Year Old Male on GLP-1 Therapy

Pdf Summary

This case report describes a 39-year-old man with obesity who developed acute severe abdominal pain and hematochezia while taking tirzepatide (Zepbound), a GLP-1 receptor agonist. Initial evaluation showed elevated inflammatory markers and CT imaging demonstrated circumferential wall thickening from the splenic flexure to the distal descending colon, raising concern for ischemic colitis. CTA showed patent mesenteric vessels, supporting a non-occlusive ischemic process. Colonoscopy revealed mucosal ulceration, friability, and congestion consistent with ischemic colitis, and biopsy later confirmed the diagnosis.<br /><br />The patient was managed supportively with IV fluids, bowel rest, and empiric antibiotics, with consultation from gastroenterology and colorectal surgery. He improved clinically without evidence of perforation or ongoing ischemia. Tirzepatide was discontinued because of a possible association with the event, and he was discharged after completing a 7-day antibiotic course with outpatient gastroenterology follow-up.<br /><br />The report emphasizes that GLP-1 receptor agonists, while effective for weight loss and glucose control, may rarely be associated with ischemic colitis. Proposed contributing mechanisms include delayed gastric emptying, constipation, reduced oral intake, increased satiety, and possible dehydration, which may lead to colonic hypoperfusion—especially in watershed regions such as the splenic flexure and rectosigmoid colon.<br /><br />Key teaching points are to recognize ischemic colitis even in younger patients without classic vascular risk factors and to maintain suspicion for GI complications in patients receiving GLP-1 therapy. Early recognition, supportive treatment, and stopping the suspected medication are important to prevent serious complications.

Asset Subtitle

Catherine Chang

Meta Tag

Author List Catherine Chang, Frida N. Cervantes Diaz, Wanna Zhang

Category Clinical Vignettes

Concept Ischemic Colitis

Concept Abdominal Pain

Concept Hematochezia

Concept GLP-1 Receptor Agonist

Concept Colonic Hypoperfusion

Distinguished Non-Finalist

Presenter Organization Rush University

Presenting Author Catherine Chang

Track Adult

Keywords

tirzepatide

Zepbound

ischemic colitis

GLP-1 receptor agonist

hematochezia

abdominal pain

colonic hypoperfusion

splenic flexure

colonoscopy

obesity

Ischemic Colitis

Abdominal Pain

Hematochezia

GLP-1 Receptor Agonist

Colonic Hypoperfusion