Severe Colonic Stenosis after Surgery for Colonic Necrosis Associated with Sodium Polystyrene Sulfonate

Abe Kaoru, Kameyama Hitoshi, Tanaka Kana, Oyanagi Hidehito, Hotta Shinnosuke, Tajima Yosuke, Nakano Mae, Nakano Masato, Shimada Yoshifumi, Sato Wataru, Umezu Hajime, Wakai Toshifumi

doi:10.3862/jcoloproctology.73.64

<p>Sodium polystyrene sulfonate (SPS) is an ion-exchange resin which is commonly used to manage hyperkalemia.</p><p>Research has demonstrated that intestinal perforation and necrosis infrequently occurs. We report a case of severe colonic stenosis after surgery for colonic necrosis regarding SPS in a 68-year-old man. The patient presented hyperkalemia due to chronic renal failure, and SPS had been administered orally. Cardiac surgery was carried out due to acute heart failure. Nine days postoperatively he presented with hematochezia with abdominal pain, which was diagnosed as ascending colon necrosis and diffuse peritonitis. We performed right hemicolectomy and double-barrelled colostomy. During restoration of the colon continuity six months later, the remnant colon and rectosigmoid colon were resected due to their stenosis. Severe stenosis and longitudinal ulceration with scarring were noted in the descending colon, and there was ulceration in the sigmoid colon. Microscopic examination revealed basophilic polygonal crystals with foreign body reaction in the colonic wall. If polystyrene sulfonate is absorbed within the colon, excretion is sometimes complicated, and it further damages the tissues as a result of chronic foreign body reaction and inflammation. Polystyrene sulfonate should be administered carefully to ascertain the range of resecting the intestine in necrosis, perforation, and enterocolitis.</p>

Severe Colonic Stenosis after Surgery for Colonic Necrosis Associated with Sodium Polystyrene Sulfonate

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