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Please prepare and upload your E-Poster no later than March 14, 2026 11.59PM CET. After this date, you will no longer be able to prepare and upload your E-poster and it will not be displayed and accessible on the congress website.
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GLP-1 receptor agonists and GLP-1/GIP co-agonists are known to inhibit gastrointestinal motility [1–4], rarely causing paralytic ileus.
This descriptive case study illustrates that a 72-year-old male with type 2 diabetes mellitus, hypertension, chronic kidney disease G3b, and prior surgical repair of intussusception in his 40s was transferred to our urology department 4.5 months prior to planned radical cystectomy. Two and a half years earlier, he was diagnosed with low-grade papillary urothelial carcinoma with early invasion and underwent five transurethral resections of bladder tumor (TUR-Bt) over 1.5 years.
His medications included rosuvastatin, hydrochlorothiazide, eplerenone 50 mg, telmisartan 80 mg, amlodipine 5 mg, and glucose-lowering agents: dapagliflozin 10 mg, glimepiride, sitagliptin 50 mg, insulin glargine, and insulin human R. One week before surgery, insulin and oral glucose-lowering agents were replaced with tirzepatide 2.5 mg weekly. Robot-assisted radical cystectomy with ileal conduit construction was performed under general anesthesia with epidural anesthesia for the conduit. Immediate postoperative labs showed pH 7.3, HCO₃⁻ 21.9 mmol/L, and creatinine 1.29 mg/dL. At discharge 20 days postoperatively, the patient had discontinued tirzepatide on his own.
First Admission (≈3 months postoperatively, 6 days) The patient presented with fatigue and malaise. Labs showed HCO₃⁻ 10 mmol/L, BE −19 mmol/L, and blood glucose 85 mg/dL. Electrolyte infusion and oral sodium bicarbonate therapy were initiated. Two weeks after discharge, tirzepatide 2.5 mg weekly was resumed.
Second Admission (≈4 months postoperatively, 10 days) Follow-up CT revealed partial obscuration of the pelvic bowel, suggesting postoperative adhesions. Tirzepatide was discontinued and replaced with sitagliptin 50 mg; the patient was discharged.
Third Admission (≈140 days postoperatively, 9 days) The patient was readmitted due to malaise. CT at ≈5 months postoperatively showed repeated ileus episodes, suggesting paralytic ileus. Hydrochlorothiazide was withheld, and sitagliptin 50 mg was temporarily stopped, then resumed around 160 days postoperatively.
Fourth Admission (≈170 days postoperatively, 5 days) The patient was readmitted for paralytic ileus. At ≈230 days postoperatively, his weight was 67 kg, blood pressure 155/78 mmHg, and no edema was noted; imaging revealed scattered small bowel dilation without a definite obstruction point. Sitagliptin 50 mg was temporarily withheld and resumed around 200 days postoperatively.
Recurrent paralytic ileus persisted after tirzepatide discontinuation, suggesting it as the primary causative agent. GLP-1 receptor agonists and GLP-1/GIP co-agonists are known to inhibit gastrointestinal motility [1–4], rarely causing paralytic ileus. Thiazide diuretics and sitagliptin may have contributed but were not direct causes. The patient’s prior intussusception and postoperative ileal conduit construction likely influenced bowel motility and fluid balance. Chronic kidney disease alters drug pharmacokinetics and intestinal sensitivity [5], potentially amplifying GLP-1RA/GIP effects. These factors highlight the need for preventive measures against postoperative adhesions and electrolyte disturbances with acidosis.
References: 1) Mathew A, Hannoodee H. Tirzepatide–Associated Partial Small Bowel Obstruction: A Case Report. J Endocr Soc. 2023;7(Suppl 1):A463. doi:10.1210/jendso/bvad114.862 2) Morgenthaler L, DePietro R. Small Bowel Obstruction After Starting Tirzepatide (Mounjaro). Am Fam Physician. 2024;110(6):562. 3) Lorenz N, Stauffer J, et al. Nonmechanical Small Bowel Obstruction in a Patient on Zepbound Without a Surgical History: A Case Report. Cureus. 2025. doi:10.7759/cureus.399219. 4)Iskander M, Wadhwa M, Kim Y, Singh N, Pathak P. Acute Functional Gastric Outlet Obstruction Associated with Low-Dose Tirzepatide. Cureus. 2025. doi:10.7759/cureus.78090. 5) Dreisbach AW, Lertora JJL. The Effect of Chronic Renal Failure on Drug Metabolism and Transport. Clin Pharmacokinet. 2008;47(8):1–17.
