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.

The Indirect Implication of SARS-CoV-2 Resulting in Kayexalate Toxicity in a Patient with Acute Kidney Injury

“…This leaves clinicians to weigh the risks and benefits of its use on a case by case basis (22). Initially, gastrointestinal mucosal injury was attributed to the sorbitol, which is commonly used in solution with the SPS; however, subsequent investigations showed that the resin itself is capable of causing injury as well (24,27,28).…”

Rapunzel Syndrome: A Rare Case of Small Bowel Intussusception in a Child

“…The location of the impaction varies as well, with the majority in the stomach, followed by the duodenum and the esophagus [2]. Patients may be asymptomatic or present with a spectrum of gastrointestinal symptoms, ranging from mild symptoms such as pain, nausea, and/or anorexia to more severe symptoms such as perforation or obstruction from mass effect or intussusception [2][3][4][5][6][7][8]. Early diagnosis and treatment of bezoars are therefore vital, with the management approach largely dependent on the type of material ingested.…”