Sevelamer crystals—an unusual cause of large bowel obstruction

Abstract

Sevelamer is a common phosphate binder used to manage hyperphosphatemia in end-stage renal disease. The medication has a well-documented gastrointestinal side-effect profile including nausea, vomiting and abdominal pain. There are few case reports of Sevelamer crystal deposition causing gastrointestinal mucosal injury, pseudotumor or obstruction. Here, we discuss a patient on Sevelamer who required operative management of a sigmoid obstruction. Surgical pathology showed pericolonic abscess with Sevelamer crystals.

Patterns of gastrointestinal injury in patients with chronic kidney disease: Comparison of cases with and without sevelamer crystals

“…In another report, a bezoar of sevelamer crystals was implicated in intestinal obstruction, but notably was at the site of a pre‐existing stricture 19 . Similar to our findings, sevelamer has been previously reported in perforated diverticula 5 . Others attribute GI bleeding to sevelamer in patients immediately after heparin infusions or initiation of haemodialysis 20,21 .…”

“…19 Similar to our findings, sevelamer has been previously reported in perforated diverticula. 5 Others attribute GI bleeding to sevelamer in patients immediately after heparin infusions or initiation of haemodialysis. 20,21 Conversely, a review of 16 reported cases by Yuste et al noted that sevelamer associated gastrointestinal injury was frequently seen in association with disorders that impair intestinal motility, such as diabetes mellitus (63%) or history of major intra-abdominal surgery (38%), but did not note an association with dose of sevelamer.…”

“…3 Rarely, sevelamer has been linked to more severe gastrointestinal complications, including bleeding, obstruction and perforation. [4][5][6] This appears to be more common among patients with other factors that affect gastrointestinal motility, such as diabetes mellitus and strictures due to prior surgery. 4 Sevelamer is composed of a carbon polymer backbone within a non-absorbable hydrogel containing ammonia.…”

“…Some patients who take sevelamer report functional gastrointestinal symptoms, including nausea, vomiting and constipation 3 . Rarely, sevelamer has been linked to more severe gastrointestinal complications, including bleeding, obstruction and perforation 4–6 . This appears to be more common among patients with other factors that affect gastrointestinal motility, such as diabetes mellitus and strictures due to prior surgery 4 …”

Cholestyramine crystal deposits as a possible cause of small bowel perforation

“…Kendte hyppige bivirkninger ved colestyraminbehandling omfatter abdominalsmerter, diarré og obstipation. Ionbytterpraeparater kan i sjaeldne tilfaelde forårsage krystalaflejringer i gastrointestinalkanalen [1], hvilket kasuistisk er beskrevet som mulig årsag til inflammation, blødning fra mave-tarm-kanalen og undtagelsesvist nekrose og perforation [2][3][4][5].…”