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Case Reports
. 2020 Aug 26;2020(8):rjaa253.
doi: 10.1093/jscr/rjaa253. eCollection 2020 Aug.

Small bowel necrosis and perforation due to sodium polystyrene sulfonate in the setting of graft versus host disease and fulminant Clostridium difficile infection

Leah Sukri  1 , Laura DiChiacchio  2 , Philip J Wasicek  2 , Stephen M Kavic  1
Affiliations
Case Reports

Small bowel necrosis and perforation due to sodium polystyrene sulfonate in the setting of graft versus host disease and fulminant Clostridium difficile infection

Leah Sukri et al. J Surg Case Rep. .

Abstract

Gastrointestinal injury is a common adverse event associated with use of sodium polystyrene sulfonate (SPS), tradename Kayexalate. Risk factors for SPS-mediated gastrointestinal necrosis include chronic kidney disease, solid organ transplant recipiency and recent surgery. This report presents a patient with past medical history significant for acute myeloid leukemia (AML) complicated by graft versus host disease (GvHD) and Clostridium difficile colitis who initially presented with small bowel obstruction. She was taken to the operating room and her small bowel pathology was significant for transmural necrosis with SPS crystals in the granulation tissue, despite last receiving SPS over a year ago. Previous mucosal damage should be considered as a risk factor for SPS-mediated injury and the effects of this medication may occur longer than previously thought.

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Figures

Figure 1
Figure 1
Small bowel biopsy revealing SPS crystals in intestinal mucosa with inflammatory changes.
See this image and copyright information in PMC

References

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