Cation Exchange Resins and colonic perforation. What surgeons need to know

Rodríguez-Luna, María Rita; Fernández-Rivera, Enrique; Guarneros-Zárate, Joaquín E.; Tueme-Izaguirre, Jorge; Hernández-Méndez, José Roberto

doi:10.1016/j.ijscr.2015.09.028

Cited by 14 publications

(12 citation statements)

References 18 publications

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“…The use of osmotic cathartics should also be avoided. The current recommendation is drug interruption, along with hemodynamic improvement to prevent gastrointestinal hypoperfusion that could lead to transmural necrosis, which was the conduct taken in this case10. Unfortunately, cecum perforation occurred a few days later.…”

Section: Discussionmentioning

confidence: 99%

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

Fiel

Santos

et al. 2019

J. Bras. Nefrol.

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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.

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Section: Discussionmentioning

confidence: 99%

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

Fiel

Santos

et al. 2019

J. Bras. Nefrol.

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“…1,3,4 There are three types of medical resins including bile acid sequestrants (BAS), potassium ion exchanger SPS and its counterpart calcium polystyrene sulfonate (CPS) and phosphate exchanger sevelamer. 1,3,4 Some are associated with gastrointestinal tract (GI) mucosal injury leading to mucosal erosion, necrosis, stenosis, perforation or formation of an inflammatory pseudotumor. [1][2][3][4][5][6] Deaths associated with SPS have also been reported.…”

Section: Discussionmentioning

confidence: 99%

“…1,3,4 Some are associated with gastrointestinal tract (GI) mucosal injury leading to mucosal erosion, necrosis, stenosis, perforation or formation of an inflammatory pseudotumor. [1][2][3][4][5][6] Deaths associated with SPS have also been reported. 1,3,5 In surgical pathology material, SPS and CPS appear as crystalline structures; basophilic with hematoxylin and eosin (H&E), blue with Diff-Quik (DQ) and magenta with periodic acid-Schiff and acid-fast stains.…”

Section: Discussionmentioning

confidence: 99%

“…1,3,5 In surgical pathology material, SPS and CPS appear as crystalline structures; basophilic with hematoxylin and eosin (H&E), blue with Diff-Quik (DQ) and magenta with periodic acid-Schiff and acid-fast stains. 3,5 None of these resins have been previously described in cytological preparations and thus their morphological features have been unknown. In our direct smears SPS is also blue with DQ and magenta with a Papanicolaou stain.…”

Section: Discussionmentioning

confidence: 99%

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Pelvic inflammatory mass associated with sodium polystyrene sulfonate crystals diagnosed by endoscopic ultrasound‐guided fine needle aspiration cytology

Banihashemi

Oza

DiMaio

et al. 2020

Diagnostic Cytopathology

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Surgical pathologists, especially those with subspecialty expertise in gastroenterological pathology, are by now relatively familiar with sodium polystyrene sulfonate (SPS) (Kayexalate, Concordia International Corp, Oakville, Ontario, Canada)-associated gastrointestinal tract injury. 1 In surgical pathology specimens, SPS typically presents as crystalline structures with a fish scale (FS) appearance. 2 To the best of our knowledge, the cytological morphology of SPS has not been previously described and there have been no previous reports of its diagnosis by fine needle aspiration (FNA). We report a case of a pelvic inflammatory mass associated with SPS diagnosed by endoscopic ultrasound-guided FNA (EUS-FNA). 2 | CASE PRESENTATION A 55 year old male developed a presumed bowel perforation following treatment with the cation-exchange resin SPS more than a decade ago. He presented to another facility several years later with a pelvic mass. Endoscopic ultrasound-guided fine needle core biopsy was performed and reported to be benign. Follow-up magnetic resonance

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“…Sodium polystyrene sulfonate, the most commonly used resin, is associated with colonic necrosis or other fatal gastrointestinal injury 1. Although rare, calcium polystyrene sulfonate still has the potential risk of severe gastrointestinal complication 2. In this case, calcium polystyrene sulfonate via nasogastric tube was diffusely retained in the gastrointestinal tract, causing severe ileus and resultant abdominal sepsis.…”

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confidence: 98%