Tirzepatide (Mounjaro), a dual glucose-dependent insulinotropic polypeptide (GIP) and glucagon-like peptide-1 (GLP-1) receptor agonist, has gained widespread adoption for the management of type 2 diabetes mellitus and obesity owing to its robust efficacy in glycemic control and weight reduction. While gastrointestinal adverse effects, including nausea, vomiting, constipation, and delayed gastric emptying, are well recognized, acute small bowel obstruction represents a rare and poorly characterized complication. We report a case of a 50-year-old woman with insulin-dependent type 2 diabetes mellitus, diabetic neuropathy, and obesity who developed acute small bowel obstruction following three months of tirzepatide therapy titrated to 12.5 mg weekly. She presented with severe abdominal pain, vomiting, abdominal distension, and syncope. Imaging confirmed small bowel obstruction without evidence of perforation, ischemia, mass lesion, or an identifiable mechanical transition point. No alternative reversible etiology for bowel obstruction was identified. Conservative management with nasogastric decompression, bowel rest, and intravenous fluid resuscitation resulted in rapid clinical improvement. Tirzepatide was discontinued, and no recurrence was observed over two months of follow-up. This case underscores small bowel obstruction as a rare but potentially serious adverse effect of tirzepatide, likely mediated by impaired gastrointestinal motility inherent to incretin-based therapy. As tirzepatide utilization continues to expand, clinicians should maintain heightened vigilance for severe gastrointestinal complications, particularly in patients with preexisting risk factors for dysmotility.
