title: Sigmoid colon diverticula perforation associated with sevelamer hydrochloride administration: A case report.
abstract: BACKGROUND
  Sevelamer is an anion exchange resin used to treat hyperphosphatemia. A common adverse effect of sevelamer is constipation. According to a review of the available literature, colon perforation associated with this resin agent was less common.
  
  
  METHODS
  A 66-year-old man complaining of lower abdominal pain was transferred to our hospital. The patient had been undergoing hemodialysis for chronic renal failure due to rapidly progressive glomerulonephritis, and had been receiving sevelamer hydrochloride 4.5 g/day for 8years as treatment for hyperphosphatemia. Abdominal computed tomography revealed ascites, free air in the abdominal cavity, multiple diverticula of the sigmoid colon, as well as increased fat tissue surrounding the sigmoid colon. We diagnosed colonic perforation and performed emergency surgery, which revealed a 5 × 5 mm perforation in the sigmoid colon surrounded with soft stool. Histopathologically, sevelamer crystals were detected at the perforation site.
  
  
  CONCLUSIONS
  We theorize that physical stimulation by sevelamer crystals contributed to colon perforation at the already vulnerable diverticulum site.
  
  
  CONCLUSIONS
  When sevelamer is administered to patients with hemodialysis, the risk of intestinal perforation should be considered.
authors.affiliation: National Hospital Organization, Department of Surgery, Kanazawa Medical Center, 1-1 Shimo-Ishibiki, Kanazawa, Ishikawa 920-8650, Japan.
authors.forename: Takahisa
authors.initials: T
authors.lastname: Yamaguchi
authors.affiliation: National Hospital Organization, Department of Surgery, Kanazawa Medical Center, 1-1 Shimo-Ishibiki, Kanazawa, Ishikawa 920-8650, Japan.
authors.forename: Shigekazu
authors.initials: S
authors.lastname: Ohyama
authors.affiliation: National Hospital Organization, Department of Surgery, Kanazawa Medical Center, 1-1 Shimo-Ishibiki, Kanazawa, Ishikawa 920-8650, Japan.
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Furukawa
authors.affiliation: National Hospital Organization, Department of Surgery, Kanazawa Medical Center, 1-1 Shimo-Ishibiki, Kanazawa, Ishikawa 920-8650, Japan.
authors.forename: Nariatsu
authors.initials: N
authors.lastname: Sato
authors.affiliation: National Hospital Organization, Department of Surgery, Kanazawa Medical Center, 1-1 Shimo-Ishibiki, Kanazawa, Ishikawa 920-8650, Japan.
authors.forename: Ichiro
authors.initials: I
authors.lastname: Ohnishi
authors.affiliation: National Hospital Organization, Department of Pathology, Kanazawa Medical Center, 1-1 Shimo-Ishibiki, Kanazawa, Ishikawa 920-8650, Japan.
authors.forename: Satomi
authors.initials: S
authors.lastname: Kasashima
authors.affiliation: National Hospital Organization, Department of Pathology, Kanazawa Medical Center, 1-1 Shimo-Ishibiki, Kanazawa, Ishikawa 920-8650, Japan.
authors.forename: Atsuhiro
authors.initials: A
authors.lastname: Kawashima
authors.affiliation: National Hospital Organization, Department of Surgery, Kanazawa Medical Center, 1-1 Shimo-Ishibiki, Kanazawa, Ishikawa 920-8650, Japan.
authors.forename: Masato
authors.initials: M
authors.lastname: Kayahara
keywords: Chronic renal failure; Colon perforation; Hemodialysis; Sevelamer crystal