Repeated Perforation of the Sigmoid Colon where Participation of Polystyrene Sulfonate was Suspected

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  • TAKAHASHI Tomohiro
    Department of Gastroenterological Surgery, Tottori University Hospital
  • KIHARA Kyoichi
    Department of Gastroenterological Surgery, Tottori University Hospital
  • HARA Kazushi
    Department of Gastroenterological Surgery, Tottori University Hospital
  • TANIO Akimitsu
    Department of Gastroenterological Surgery, Tottori University Hospital
  • YAMAMOTO Manabu
    Department of Gastroenterological Surgery, Tottori University Hospital
  • FUJIWARA Yoshiyuki
    Department of Gastroenterological Surgery, Tottori University Hospital

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Other Title
  • ポリスチレンスルホン酸塩の関与が疑われた反復性S状結腸穿孔の1例
  • 症例 ポリスチレンスルホン酸塩の関与が疑われた反復性S状結腸穿孔の1例
  • ショウレイ ポリスチレンスルホン サンエン ノ カンヨ ガ ウタガワレタ ハンプクセイ Sジョウ ケッチョウ センコウ ノ 1レイ

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Abstract

<p>An 84-year-old man who had been taking calcium polystyrene sulfonate (CPS) for diabetic renal failure and hyperkalemia presented to our emergency clinic because of left lower quadrant abdominal pain. An abdominal CT scan revealed free air around the sigmoid colon. We performed an emergency operation with a diagnosis of panperitonitis due to perforation of the sigmoid colon. Intraoperative findings revealed perforation with the size of a tip of the thumb in the sigmoid colon, from where hard stools exposed. Accordingly, we performed Hartmann's operation. He developed abdominal pain again on the 6th postoperative day, and re-perforation at the peduncle of the stoma was diagnosed from CT findings. Relaparotomy disclosed reperforation of the colon at 10 cm proximal to the stoma. We resected the colon from the stoma to the reperforation and created a colostomy. Histopathology revealed precipitation of basophilic polygonal crystalline foreign materials associated with inflammatory cell infiltration at the perforated site, strongly suggesting coating with CPS.</p><p>Colorectal perforation in patients who are taking oral CPS can be fatal due to general disorder associating with chronic renal failure. In order to avoid repeated perforation, we are required surgical devices such as aggressive removal of hard stools and larger penetrating part through the abdominal wall.</p>

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