An elderly female with onset of colonic perforation recognized as crystalline material in the perforated site while taking calcium polystyrene sulfonate

Abstract

A 90-year-old female patient had been undergoing hemodialysis three times a week due to chronic renal failure caused by MPO-ANCA involving nephropathy since August 2002 ; she had subsequently been taking calcium polystyrene sulfonate (CPS) because of uncontrollable hyperkalemia. In mid-December 2012, the patient visited an emergency outpatient service due to abdominal pain and was observed showing abnormal air patterns in the abdominal cavity and hard feces in the colon by using abdominal computed tomography. We diagnosed the case as gastrointestinal perforation and diffuse peritonitis, and then decided to perform an emergency operation. We recognized a perforation in the descending colon, and performed both transverse colostomy and descending colon resection, and also conducted transverse colostomy. We recognized a crystalline material at the perforated site, which suggested the possibility that the CPS was associated with this colonic perforation. The patient died on the fourth day of illness due to disseminated intravascular coagulation and septicemia, although we had performed multimodal therapy. CPS is a cation exchange resin used to correct hyperkalemia, but it has adverse effects such as obstipation that occurs with high frequency. Some reports suggest that this drug is associated with intestinal perforation, and the drug package insert also warns of this. We conclude that we need to pay attention to the control of defecation during dosing of calcium polystyrene sulfonate.