A Case of Cecal Ulcer Hemorrhage in a Hemodialysis Patient Taking Sodium Polystyrene Sulfonate

• Published in: Nihon Fukubu Kyukyu Igakkai Zasshi (Journal of Abdominal Emergency Medicine) Vol. 38; no. 6; pp. 1037 - 1041
• Main Authors: Masaki, Tadahiko, Mori, Toshiyuki, Momose, Hirokazu, Sugiyama, Masanori, Kojima, Koichiro
• Format: Journal Article
• Language: Japanese
• Published: Japanese Society for Abdominal Emergency Medicine 30.09.2018; 日本腹部救急医学会
• Subjects: ポリスチレンスルホン酸ナトリウム; 消化管出血; 盲腸潰瘍
• ISSN: 1340-2242; 1882-4781
• DOI: 10.11231/jaem.38.1037

A 41-year-old man complained of right lower abdominal pain, vomiting and diarrhea. He was suffering chronic renal failure with Alport syndrome and had been treated with hemodialysis and sodium polystyrene sulfonate（Kayexalate, SPS） from 25 years previously. Abdominal computed tomography suggested ascending colon diverticulitis. Conservative treatment with antibiotics improved the abdominal pain and inflammatory response. However, a massive hemorrhagic stool （1,600g） was observed after hemodialysis on the 11th day. Since colonoscopic hemostasis was difficult due to massive hemorrhage in the right side colon, a right hemicolectomy was performed and an ileostomy with a transverse mucous fistula was carried out on the 15th day. Pathological examination revealed a 30mm, poorly defined ulcer in the cecum, accompanied with crystalline material, suggesting an SPS related ulcer. Although commonly used for improving hyperkalemia in patients with chronic renal failure, SPS may sometimes induce severe intestinal injury.