RT Journal Article
SR Electronic
T1 Lessons of the month 3: Duodenal perforation after polystyrene sulfonate
JF Clinical Medicine
JO Clin Med
FD Royal College of Physicians
SP 107
OP 109
DO 10.7861/clinmed.2019-0327
VO 20
IS 1
A1 Winston WS Fung
A1 Wai Kin Chi
A1 Cheuk Chun Szeto
A1 Philip K-T Li
A1 Kai Ming Chow
YR 2020
UL http://www.rcpjournals.org/content/20/1/107.abstract
AB Ion-exchange resins, sodium or calcium polystyrene sulfonate, are commonly used medications for management of hyperkalaemia. However, the drug can be associated with serious bowel injury. We report a case of a renal transplant recipient who developed duodenal ulcer perforation secondary to the use of calcium polystyrene sulfonate. Characteristic eosinophilic non-polarisable rhomboid shaped crystals were evident in the affected area of ulceration on histologic examination in addition to features of cytomegalovirus inclusions. We also hypothesised that gastroparesis secondary to autonomic dysfunction could have led to prolonged luminal contact time with polystyrene, further predisposing to bowel injury.