eP172 Tirzepatide Mimicking /Causing Acute Surgical Abdomen: A Two-Case Experience

Background Tirzepatide, a dual GIP and GLP-1 receptor agonist, has shown remarkable efficacy in managing type 2 diabetes and obesity. However, its potential to cause gastrointestinal complications or mimic acute surgical conditions is increasingly being recognised. This abstract highlights two unique cases of patients presenting with features suggestive of a surgical abdomen, later attributed to tirzepatide use. Case 1 A 57-year-old woman on tirzepatide for weight loss presented with acute abdominal pain and persistent vomiting. Blood investigations revealed significantly elevated amylase, with normal lipid profile and liver function tests. Magnetic resonance cholangiopancreatography (MRCP) ruled out gallstones, biliary sludge, or structural abnormalities. No other medications or conditions explained the symptoms. After excluding other causes, the presentation was attributed to tirzepatide-induced pancreatitis. Case 2 A 37-year-old woman presented with severe abdominal pain, vomiting, and clinical signs of acute abdomen. Blood investigations showed elevated lactate, while CT imaging revealed only an incidental ovarian cyst, insufficient to explain her symptoms. Due to concerning clinical features, she underwent an exploratory laparotomy, which found no pathology. Postoperatively, the patient disclosed her use of tirzepatide. Retrospective analysis raised suspicion of this drug as the cause of her symptoms. Discussion These cases underline the potential of tirzepatide to mimic serious intra-abdominal conditions, leading to unnecessary surgical interventions. While the exact mechanism remains unclear, altered gastrointestinal motility and inflammation may play roles. Conclusion In patients presenting with acute abdominal symptoms, a thorough drug history, including tirzepatide use, is crucial. Recognising this potential adverse effect can prevent unwarranted surgical procedures.