Asymptomatic Cecal Perforation in a Renal Transplant Recipient After Sodium Polystyrene Sulfonate Administration

Abstract

Sodium polystyrene sulfonate (SPS) is a medication commonly used for the treatment of hyperkalemia. There have been many cases of colonic necrosis and perforation associated with administration of SPS. There are very few such cases reported in renal transplant patients. We present a case of renal transplant recipient who developed cecal perforation after a single oral dose of SPS. She had no signs or symptoms suggestive of intestinal perforation and was incidentally diagnosed with it on abdominal imaging performed to find cause of acute blood loss anemia. This case underlines the importance of recognizing this severe and potentially life-threatening complication associated with SPS. The clinicians should also consider renal/solid organ transplant and immunosuppression as potential risk factors.

Intestinal necrosis after co‐administration of sodium polystyrene sulfonate and activated charcoal

“…Based on the previously reported studies mentioned above, we believe that our patient was at high risk of intestinal necrosis from sorbitol due to uremia and history of renal transplant. 9 This case underlines the importance of recognizing a rare, severe, and potentially life-threatening complication of AC and SPS, and the risk factors associated with it. Concomitant use of AC and SPS should be avoided in these high-risk patients.…”

Novel approaches to management of hyperkalaemia in kidney transplantation

“…These complications mainly appear on the ileum and colon, but can also affect the upper gastrointestinal tract to cause bleeding, ischemic colitis, focal to deep ulceration, necrosis and perforation, and faecal impaction with rectal stenosis [47,48]. Kidney transplantation and immunosuppression are considered potential risk factors for developing intestinal necrosis after SPS administration [49]. Other risk factors include history of intestinal disease, surgery, hypovolemia and renal failure [44,47].…”