Semaglutide initiation unmasks adult annular pancreas, causing gastric outlet obstruction in 55-year-old male
Background
Annular pancreas is a rare congenital anomaly where pancreatic tissue encircles the duodenum, often remaining asymptomatic until adulthood. While typically benign, it can cause gastric outlet obstruction or duodenal stenosis. Glucagon-like peptide-1 receptor agonists (GLP-1 RAs) like semaglutide are widely used for type 2 diabetes and obesity, primarily by enhancing insulin secretion and delaying gastric emptying. This delayed gastric emptying, a common side effect, can mask or exacerbate underlying mechanical obstructions, posing a diagnostic challenge and potentially delaying crucial interventions for structural pathologies.
Study Design
This case report describes a 55-year-old male with type 2 diabetes who developed severe gastrointestinal symptoms following initiation of semaglutide. The patient presented with progressive postprandial vomiting and significant weight loss. Diagnostic imaging, including CT and MRI, was performed to investigate the cause of his symptoms. Following the diagnosis of annular pancreas causing duodenal stenosis, semaglutide was discontinued. Surgical intervention, specifically a Roux-en-Y gastrojejunostomy and cholecystectomy, was performed to alleviate the obstruction. Histopathological examination of the resected tissue confirmed the benign nature of the pancreatic tissue.
Results
Following semaglutide initiation, the patient developed progressive postprandial vomiting and experienced a nine-kg weight loss. Imaging studies revealed a partial annular pancreas causing second-part duodenal stenosis, with no signs of malignancy. Crucially, symptoms persisted even after semaglutide discontinuation, strongly supporting a fixed mechanical obstruction as the primary etiology rather than medication side effects alone. Histopathology of the resected tissue confirmed benign fibrotic pancreatic tissue. At follow-up, the patient was symptom-free, demonstrating nutritional recovery post-surgery. This case highlights that severe GI symptoms in patients on GLP-1 RAs warrant thorough evaluation for structural pathology.
The patient underwent successful
Roux-en-Y gastrojejunostomyandcholecystectomy, leading to complete symptom resolution and nutritional recovery.
Key Findings
- Semaglutide initiation preceded progressive postprandial vomiting and 9-kg weight loss in a 55-year-old male.
- Imaging revealed a partial annular pancreas causing second-part duodenal stenosis.
- Symptoms persisted despite semaglutide discontinuation, indicating a fixed mechanical obstruction.
- Successful
Roux-en-Y gastrojejunostomyresolved symptoms and led to nutritional recovery. - Histopathology confirmed benign fibrotic pancreatic tissue.
Why It Matters
This case underscores a critical clinical consideration for individuals using GLP-1 RAs like semaglutide: severe gastrointestinal symptoms should not be automatically attributed to medication side effects. Clinicians must maintain a high index of suspicion for underlying structural pathologies, such as annular pancreas, especially when symptoms are persistent or unusually severe. For peptide users and biohackers, this means being vigilant for symptoms that deviate from typical GLP-1 RA side effect profiles, prompting a medical evaluation. Early and accurate diagnosis can prevent prolonged suffering and ensure timely surgical intervention, as demonstrated by the successful Roux-en-Y gastrojejunostomy in this patient. This case does not alter dosing or stacking protocols but emphasizes the importance of diagnostic diligence.
semaglutide
annular-pancreas
gastric-outlet-obstruction
case-report
type-2-diabetes
gastrointestinal