Colonic Ischemia Following Semaglutide Use: A Case Report

Introduction: Glucagon-like peptide-1 (GLP-1) agonist and combined GLP-1 and glucose-dependent insulinotropic polypeptide (GIP) agonist use has dramatically increased in recent years. While their side effect profile is often manageable, they can lead to serious complications. Case Presentation: We present a case of colonic ischemia in a young patient who experienced significant nausea, vomiting, and abdominal pain after initiation of semaglutide. Imaging was unremarkable, but after an episode of hematochezia, a colonoscopy was performed, which grossly showed signs of colonic ischemia with biopsied tissue demonstrating changes consistent with ischemic mucosa. A comprehensive hematology, cardiology, and gastrointestinal workup was performed, which did not elucidate a cause for the colonic ischemia. The likely cause was deemed to be hypovolemia resulting from the recent initiation of semaglutide. Conclusions: Following initiation of semaglutide, other GLP-1 agonists, or dual GLP-1/GIP dual agonists, practitioners should be aware of the possible severe complications, such as colonic ischemia, and properly educate their patients of these risks.