Two Chronic Kidney Disease Patients Under Maintenance Dialysis with Calcium Polystyrene Sulfonate-induced Sigmoid Colon Perforation.

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  • Seki Junichi
    Digestive Disease Center, Showa University Northern Yokohama Hospital
  • Shimada Shoji
    Digestive Disease Center, Showa University Northern Yokohama Hospital
  • Nakagawa Mihoko
    Digestive Disease Center, Showa University Northern Yokohama Hospital
  • Kakisako Kensuke
    Digestive Disease Center, Showa University Northern Yokohama Hospital
  • Oae Sonoko
    Digestive Disease Center, Showa University Northern Yokohama Hospital
  • Takano Yojiro
    Digestive Disease Center, Showa University Northern Yokohama Hospital
  • Tonouchi Akiko
    Digestive Disease Center, Showa University Northern Yokohama Hospital
  • Nakahara Kenta
    Digestive Disease Center, Showa University Northern Yokohama Hospital
  • Takehara Yusuke
    Digestive Disease Center, Showa University Northern Yokohama Hospital
  • Mukai Shumpei
    Digestive Disease Center, Showa University Northern Yokohama Hospital
  • Enami Yuta
    Digestive Disease Center, Showa University Northern Yokohama Hospital
  • Sawada Naruhiko
    Digestive Disease Center, Showa University Northern Yokohama Hospital
  • Ishida Fumio
    Digestive Disease Center, Showa University Northern Yokohama Hospital
  • Kudo Shin-ei
    Digestive Disease Center, Showa University Northern Yokohama Hospital
  • Nemoto Tetsuo
    Department of Pathology, Showa University Northern Yokohama Hospital

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Other Title
  • ポリスチレンスルホン酸カルシウム内服中の血液透析患者に発症したS状結腸穿孔の2例
  • ポリスチレンスルホンサン カルシウム ナイフク チュウ ノ ケツエキ トウセキ カンジャ ニ ハッショウ シタ Sジョウ ケッチョウ センコウ ノ 2レイ

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Abstract

<p>Calcium polystyrene sulfonate（CPS）is a cation exchange resin that is used for treating hyperkalemia in patients with renal failure. This drug causes hard stools and constipation. As a serious side effect, intestinal tract perforation has also been reported. We report two cases of patients with chronic kidney disease（CKD）under maintenance hemodialysis who developed CPS-induced sigmoid colon perforation. Case 1 was an 88-year-old woman, and Case 2 was a 76-year-old man; both had CKD and were undergoing maintenance hemodialysis. In both cases, surgical exploration revealed sigmoid colon perforation near the mesenteric side. Histopathological examination of the resected specimen revealed accumulation of CPS crystals in the intestinal wall around the perforation site in both cases. In CKD patients, as the intestinal wall is already vulnerable due to chronic blood flow disturbance caused by uremia and arterial sclerosis, the risk of intestinal perforation associated with increase of the intestinal pressure is high in these patients. Therefore, appropriate measures for defecation control is important in patients with CKD started on treatment with CPS.</p>

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