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Case Reports
. 2021 Apr 24;2021(4):rjab135.
doi: 10.1093/jscr/rjab135. eCollection 2021 Apr.

Small crystals with severe consequences

Jennifer M Klasen  1 , Caspar J Peterson  1 , Lana L Fourie  1 , Tuyana Boldanova  2 , Luigi M Terracciano  3 , Andreas Holbro  4 , Otto Kollmar  1
Affiliations
Case Reports

Small crystals with severe consequences

Jennifer M Klasen et al. J Surg Case Rep. .

Abstract

We present the case of a 23-year-old patient who developed a severe gastric ischemia after the ingestion of a single dose of sodium polystyrene sulfonate (SPS) orally. Emergency surgery confirmed extensive full thickness gastric necrosis, prompting a total gastrectomy. Histopathology showed kayexalate crystals in the gastric wall, suggesting SPS-related ischemic gastritis. After radical resection of the affected stomach, this young patient was able to fully recover. Although effective, the widespread use of SPS to treat hyperpotassemia remains a debated topic because of rare but serious adverse events like the forming of kayexalate crystal residues in the gastrointestinal tract. These crystal residues are mostly found in the large intestine and can lead to ulceration and necrosis. Physicians need to be aware of this rare but potentially devastating adverse effect of SPS ingestion.

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Figures

Figure 1
Figure 1
Shown is air in the gastric wall (red arrow) and air in the hepatic portal venous system (blue arrow)
Figure 2
Figure 2
Shown is a large necrotic area in the gastric fundus and corpus along the greater curvature
Figure 3
Figure 3
Shown is the resected stomach with extensive macroscopic signs of ischemic necrosis, primarily in the fundus and corpus. (A) Anterior view. (B) Posterior view
Figure 4
Figure 4
(A) Histopathology reveals signs of acute gastritis and ischemic tissue areas. Crystalline structures are found in the gastric tissue. (B) Gastric tissue crystals morphologically consistent with kayexalate crystals, suggesting SPS-related ischemic gastritis
See this image and copyright information in PMC

References

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