A CASE OF PERITONITIS WITH SIGMOID COLON PERFORATION THAT DEVELOPED DURING ADMINISTRATION OF CALCIUM POLYSTYRENE SULFONATE (ARGAMATE JELLY)

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  • TAKAHASHI Hiroki
    Department of Gastroenterological Surgery, Nagoya City University Graduate School of Medical Sciences
  • IMAFUJI Hiroyuki
    Department of Gastroenterological Surgery, Nagoya City University Graduate School of Medical Sciences
  • HARA Masayasu
    Department of Gastroenterological Surgery, Nagoya City University Graduate School of Medical Sciences
  • SATOH Mikinori
    Department of Gastroenterological Surgery, Nagoya City University Graduate School of Medical Sciences
  • TAKEYAMA Hiromitsu
    Department of Gastroenterological Surgery, Nagoya City University Graduate School of Medical Sciences

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  • ポリスチレンスルホン酸カルシウム（アーガメイトゼリー）内服中に発症したＳ状結腸穿孔性腹膜炎の１例

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The patient was a 79-year-old woman who had been receiving calcium polystyrene sulfonate (Argamate jelly) for hyperkalemia associated with chronic renal failure. She visited a local doctor following sudden onset of lower abdominal pain on April 3, 2008. After being diagnosed with perforative peritonitis, she was immediately transferred to our hospital and underwent emergency surgery on the same day. Laparotomy revealed an extremely hard fecal mass in the sigmoid colon that was impacting the sigmoid colon. Approximately 10 cm of the serosa in the upper intestinal tract was ruptured, and a perforation (1.5 cm) was observed in the ruptured area. The sigmoid colon, including the lesion site, was resected, and peritoneal drainage and Hartmann's procedure were performed. Multimodality therapy was given postoperatively, and the patient survived. Pathological findings included a crystalline material at the lesion site as well as in the fecal mass, suggesting that the administration of Argamate jelly played a major role in the onset of sigmoid colon perforation. The present case indicates the importance of control of bowel movement during administration of this drug.

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