Cecum perforation associated with a calcium polystyrene sulfonate bezoar - a rare entity.

Abstract

Hyperkalemia is one of the most common electrolyte disorders, responsible for a high number of adverse outcomes, including life-threatening arrhythmias. Potassium binders are largely prescribed drugs used for hyperkalemia treatment but unfortunately, there are many adverse events associated with its use, mostly gastrointestinal. Identification of patients at highest risk for the serious complications associated with the current potassium binders, such as colon necrosis and perforation, could prevent fatal outcomes. The authors present a case of a 56-year-old man with secondary diabetes and chronic renal disease that was treated for hyperkalemia with Calcium Polystyrene Sulfonate (CPS). He later presented with acute abdomen due to cecum perforation and underwent ileocecal resection but ultimately died from septic shock a week later. During surgery, a solid white mass was isolated in the lumen of the colon. The mass was identified as a CPS bezoar, a rare drug-mass formed in the gastrointestinal tract that contributed to the perforation. A previous history of partial gastrectomy and vagothomy was identified as a probable risk factor for the CPS bezoar development. Hopefully, the two new potassium binders patiromer and (ZS-9) Sodium Zirconium Cyclosilicate will help treat such high-risk patients, in the near future.

• Authors: David Carvalho Fiel, Iolanda Santos, Joana Eugénio Santos, Rita Vicente, Susana Ribeiro, Artur Silva, Beatriz Malvar, Carlos Pires
• Journal: Jornal brasileiro de nefrologia : 'orgao oficial de Sociedades Brasileira e Latino-Americana de Nefrologia (J Bras Nefrol) 2019 Jul-Sep Vol. 41 Issue 3 Pg. 440-444 ISSN: 2175-8239 [Electronic] Brazil
• PMID: 30534857 (Publication Type: Case Reports, Journal Article)

Chemical References

• Polymers
• Polystyrenes
• Silicates
• patiromer
• polystyrene sulfonic acid
• sodium zirconium cyclosilicate

Topics

• Bezoars (complications)
• Cecum (pathology)
• Diabetes Mellitus (etiology)
• Fatal Outcome
• Humans
• Hyperkalemia (drug therapy, etiology)
• Intestinal Perforation (etiology, surgery)
• Male
• Middle Aged
• Polymers (therapeutic use)
• Polystyrenes (adverse effects, therapeutic use)
• Renal Insufficiency, Chronic (complications)
• Shock, Septic (mortality)
• Silicates (therapeutic use)