title: Ileum and colon perforation following peritoneal dialysis-related peritonitis and high-dose calcium polystyrene sulfonate.
abstract: A rare but severe complication, intestinal necrosis, has been reported after sodium polystyrene sulfonate (SPS; Kayexalate) and sorbitol intake. Some case reports described bowel perforation following calcium polystyrene sulfonate (CPS; Kalimate) administration. We report a case of ileum and colon perforation following peritoneal dialysis-related peritonitis and high-dose Kalimate in a 59-year-old female patient. The patient had a history of hypertension, diabetes mellitus, and end-stage renal disease (ESRD). During hospitalization for peritoneal dialysis-related peritonitis, she developed hyperkalemia, and Kalimate was administered orally. However, severe abdominal distension and pain occurred just one day after Kalimate intake. An urgent surgery disclosed several perforations in the ileum and sigmoid colon. Pathology of the resected gut showed transmural necrosis and perforation with basophilic angulated crystals. The patient finally expired during hospitalization due to refractory septic shock.
authors.affiliation: Division of Nephrology, Department of Internal Medicine, National Taiwan University Hospital, National Taiwan University, College of Medicine, Taipei, Taiwan; Department of Internal Medicine, Taipei Medical University Hospital, Taipei, Taiwan.
authors.forename: Chih-Chin
authors.initials: CC
authors.lastname: Kao
authors.affiliation: Division of Nephrology, Department of Internal Medicine, National Taiwan University Hospital, National Taiwan University, College of Medicine, Taipei, Taiwan.
authors.forename: Yi-Chiun
authors.initials: YC
authors.lastname: Tsai
authors.affiliation: Division of Nephrology, Department of Internal Medicine, National Taiwan University Hospital, National Taiwan University, College of Medicine, Taipei, Taiwan.
authors.forename: Wen-Chih
authors.initials: WC
authors.lastname: Chiang
authors.affiliation: Department of Pathology, National Taiwan University Hospital, National Taiwan University, College of Medicine, Taipei, Taiwan.
authors.forename: Tsui-Lien
authors.initials: TL
authors.lastname: Mao
authors.affiliation: Division of Nephrology, Department of Internal Medicine, National Taiwan University Hospital, National Taiwan University, College of Medicine, Taipei, Taiwan. Electronic address: twkao2@ntuh.gov.tw.
authors.forename: Tze-Wah
authors.initials: TW
authors.lastname: Kao
mesh_terms: D003106:Colon / Q000473:pathology; D017809:Fatal Outcome; D005260:Female; D006801:Humans; D006947:Hyperkalemia / Q000175:diagnosis; D007082:Ileum / Q000473:pathology; D007416:Intestinal Perforation / Q000601:surgery*; D007676:Kidney Failure, Chronic / Q000628:therapy*; D008875:Middle Aged; D009336:Necrosis / Q000473:pathology; D010530:Peritoneal Dialysis / Q000009:adverse effects*; D010538:Peritonitis / Q000175:diagnosis; D011137:Polystyrenes / Q000009:adverse effects*; D012772:Shock, Septic / Q000175:diagnosis*; D013012:Sorbitol / Q000009:adverse effects*
chemical_list: D011137:Polystyrenes; D013012:Sorbitol; C003321:polystyrene sulfonic acid
keywords: Kalimate; bowel/intestinal perforation; end-stage renal disease