Great Weight, Low Pressure–One Problem: GLP-1 Receptor Agonist-Associated Colonic Ischemia

A 37-year-old Caucasian woman was evaluated in the emergency department for sudden onset of severe left lower quadrant abdominal pain associated with nausea and vomiting. Her past medical history included mild well-controlled hypertension, polycystic ovarian syndrome, chronic endometriosis, migraine headaches, and obesity. Medications on admission included bupropion and ondansetron as needed for nausea. Four months before her presentation, therapy with the glucagon-like peptide-1 (GLP-1) receptor agonist (RA), Wegovy™ (semaglutide) 0.5 mg subcutaneously once weekly was initiated to control obesity (BMI = 35). She reported constipation since starting Wegovy. During an office visit five weeks before, she had lost approximately 30 pounds, down to a BMI of 30. At that time, her Wegovy dose was increased to 1 mg subcutaneously once weekly, after which she started experiencing worsening constipation. …