MON-681 Dulaglutide Commonly Known as Trulicity; An Anti-Diabetic Medication Causing Small Bowel Obstruction

Abstract

Introduction Small bowel obstruction is a common and life threatening surgical emergency. The general causes are intra and extra-intestinal mechanical obstruction, such as from post-operative adhesions, malignancy, hernias, Crohn’s disease, and volvulus. Less frequently neurologic, metabolic, and medications interfere with intestinal motility and lead to obstructive features. Here, we present a rare case of small intestinal obstruction caused by the anti-diabetic glucagon-like peptide 1 (GLP-1) agonist, Dulaglutide (Trulicity). Case A 52-year-old male with Diabetes Mellitus, presented with two weeks of severe nausea and vomiting, accompanied by four days of diffused abdominal pain. CT scan of the abdomen showed multiple mildly distended dilated loops of the proximal jejunum. The results lead to suspect the presence of fecal stasis with an apparent transition zone of a normal caliber bowel. This is strongly indicative of partial or evolving small bowel obstruction. The patient was treated with conservative management of bowel rest and NG tube per the surgery on board. However, patient deteriorated too quickly and the partial bowel obstruction lead to full obstruction and eventually taken for an emergent surgery. With careful investigation to identify underlying causes of small bowel obstruction revealed no mechanical, structural, or metabolic explanation. However, a review of patient’s medication list disclosed a daily consumption of Dulaglutide (Trulicity). The medication was started 3 weeks prior to admission. He started developing partial bowel obstruction symptoms within one week of starting the medications. Unfortunately, surgeon ended up performing a partial resection a small bowel due to severe ischemia. Patient improved clinically in four to five days and was discharged home with an alternative anti-diabatic medications. He follows up with us in the clinic and has no signs of bowel obstructions with the other anti-diabatic medications. Discussion: Dulaglutide (Trulicity) is associated with small bowel obstruction. The side effect is more common in males and in patients who are using the medication for less than one month. A total of 8 cases were reported in 2017 with majority of them requiring surgical intervention for the small bowel obstruction. In our patient, it also required a surgical intervention and was life threatening. Unfortunately, the actual mechanism Trulicity causing the small bowel obstruction is unknown; however the moderate side effect of Trulicity is constipation. In this case, our patient was not constipated. He had normal bowel movements on a regular basis. Also, he never had any history of abdominal surgeries which can cause adhesion and lead to small bowel obstruction. All the other caused of small bowel obstructions had been ruled out and finally concluded Trulicity was the culprit of this unfortunate case.