Two Cases of Sigmoid Colon Perforation Occurred during Calcium Polystyrene Sulfonate Intake

Abstract

Serious complications associated with oral intake of calcium polystyrene sulfate (CPS) include intestinal perforations and intestinal necrosis probably caused by constipation. We herein report, along with a review of the literature, on two cases of sigmoid colon perforation and panperitonitis occurred during oral intake of CPS for chronic kidney disease (CKD) and hyperkalemia in our institution. Patient 1 was an 87-year-old woman who was taking CPS for CKD and hyperkalemia and visited our hospital because of abdominal distention and hypogastric pain. Panperitonitis was diagnosed, and Hartmann's operation was carried out. We observed multiple ulcers with perforation in the sigmoid colon and CPS crystals on the ulcer floor. Although sepsis and DIC occurred following the surgery and required multidisciplinary therapy, she was discharged home with remission. Patient 2 was an 86-year-old woman taking CPS for CKD and hyperkalemia. She visited our hospital because of emesis and hypogastric pain. Sigmoid colon perforation and panperitonitis were diagnosed, and Hartmann's operation was carried out. There were CPS crystals in the perforated region of the sigmoid colon, which were thought to be the cause of the perforation. Although the peritonitis could be controlled, ARDS occurred following the surgery and she died due to the progression of respiratory failure. It is necessary to take notice of evacuation control for renal dysfunction patients with oral intake of CPS.