A 78-year-old man with acute right lower abdominal pain and nausea was referred to our hospital. Computed tomography (CT) demonstrated hepatic portal venous gas and a thickened wall of the terminal ileum, and colonoscopy demonstrated ulcers and erosions of the ileocecal region. Histological examination of biopsy samples revealed basophilic crystals consistent with the component of calcium polystyrene sulfonate (CPS). This patient started taking CPS 2 months prior for chronic hyperkalemia. The symptoms resolved soon after ceasing CPS, and subsequent imaging studies confirmed the disappearance of the portal venous gas and ileocolitis.
Calcium polystyrene sulfonate Hepatic portal venous gas Ileocecal ulcer
This is a preview of subscription content, log in to check access.
Compliance with ethical standards
Conflicts of interest
Toshiyuki Kubo, Kentaro Yamashita, Yoshihiro Yokoyama, Daisuke Hirayama, Tomohiro Shirata, Kei Mitsuhashi, Kei Onodera, Eiichiro Yamamoto, Katsuhiko Nosho, Hiroo Yamano, Terufumi Kubo, Shintaro Sugita, Tadashi Hasegawa and Hiroshi Nakase that they have no conflict of interest
All procedures followed have been performed in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki and its later amendments.
Informed consent was obtained from all patients for being included in the study.
Harel Z, Harel S, Shah PS, et al. Gastrointestinal adverse events with sodium polystyrene sulfonate (Kayexalate) use: a systematic review. Am J Med. 2013;126:e9–24.CrossRefGoogle Scholar
Arvanitakis C, Malek G, Uehling D. Colonic complications after renal transplantation. Gastroenterology. 1973;64:533–8.PubMedGoogle Scholar
Shioya T, Yoshino M, Ogata M, et al. Successful treatment of a colonic perforation penetrating the urinary bladder caused by the administration of calcium polystyrene sulfonate and sorbitol. J Nippon Med Sch. 2007;74:359–63.CrossRefPubMedGoogle Scholar
Goutorbe P, Montcriol A, Lacroix G, et al. Intestinal necrosis associated with orally administered calcium polystyrene sulfonate without sorbitol. Ann Pharmacother. 2011;45:e13.CrossRefPubMedGoogle Scholar
Akagun T, Yazici H, Gulluoglu MG, et al. Colonic necrosis and perforation due to calcium polystyrene sulfonate in a uremic patient: a case report. NDT Plus. 2011;4:402–3.PubMedPubMedCentralGoogle Scholar
Kao CC, Tsai YC, Chiang WC, et al. Ileum and colon perforation following peritoneal dialysis-related peritonitis and high-dose calcium polystyrene sulfonate. J Formos Med Assoc. 2015;114:1008–10.CrossRefPubMedGoogle Scholar
Castillo-Cejas MD, de-Torres-Ramírez I, Alonso-Cotoner C. Colonic necrosis due to calcium polystyrene sulfonate (Kalimate) not suspended in sorbitol. Rev Esp Enferm Dig. 2013;105:232–4.CrossRefPubMedGoogle Scholar
Lai TP, Yang CW, Siaop FY, et al. Calcium polystyrene sulfonate bezoar in the ileum: diagnosis and treatment with double-balloon endoscopy. Endoscopy. 2013;45(Suppl 2 UCTN):E378–9.PubMedGoogle Scholar
Takeuchi N, Nomura Y, Meda T, et al. Development of colonic perforation during calcium polystyrene sulfonate administration: a case report. Case Rep Med. 2013;2013:102614.PubMedPubMedCentralGoogle Scholar
Lillemoe KD, Romolo JL, Hamilton SR, et al. Intestinal necrosis due to sodium polystyrene (Kayexalate) in sorbitol enemas: clinical and experimental support for the hypothesis. Surgery. 1987;101:267–72.PubMedGoogle Scholar
Ayoub I, Oh MS, Gupta R, et al. Colon necrosis due to sodium polystyrene sulfonate with and without sorbitol: an experimental study in rats. PLoS ONE. 2015;10:e0137636.CrossRefPubMedPubMedCentralGoogle Scholar