Abstract
We report a patient undergoing maintenance dialysis who developed life-threatening intestinal perforation during bixalomer therapy, which was successfully treated by prompt surgical intervention. A 75-year-old man had been treated with bixalomer at 3,000 mg/day for 3 months prior to hospitalization for the control of decreased serum phosphate level. He suddenly suffered lower abdominal pain and was admitted to our hospital. Imaging diagnosis (computed tomography of the abdomen and pelvis) identified intestinal perforation and emergency surgery was performed on the same day. Following the surgery, multidisciplinary therapy, including polymyxin B-immobilized fiber column-direct hemoperfusion (PMX-DHP) and continuous hemodiafiltration (CHDF), was administered, and the patient successfully recovered. Bixalomer is a phosphate binder with a reportedly lower rate of gastrointestinal events such as constipation and abdominal distention than other phosphate binders. Although no case of intestinal perforation occurring during bixalomer therapy has yet been reported, this drug is likely to carry the risk of intestinal perforation.
