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

Abstract 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.

摘要 高钾血症（Hyperkalemia）是最常见的电解质紊乱之一，可引发多种不良结局，其中包括危及生命的心律失常。钾结合剂（Potassium binders）是临床广泛用于高钾血症治疗的处方药物，但此类药物的使用常伴随多种不良反应，其中以胃肠道反应最为多见。识别出当前钾结合剂相关严重并发症（如结肠坏死、肠穿孔）风险最高的患者，可避免致命性结局的发生。本文作者报告一例病例：患者为56岁男性，患有继发性糖尿病与慢性肾病，因高钾血症接受聚苯乙烯磺酸钙（Calcium Polystyrene Sulfonate, CPS）治疗。此后患者因盲肠穿孔出现急腹症，接受回盲部切除术，但最终于一周后因感染性休克离世。术者于患者结肠肠腔内检出一处实性白色肿物，经鉴定为CPS粪石（CPS bezoar）——一种罕见的胃肠道内形成的药物性肿物，亦是本次肠穿孔的诱因。患者既往有部分胃切除术与迷走神经切断术病史，该病史被认为是CPS粪石形成的潜在危险因素。值得期待的是，两款新型钾结合剂——帕特罗默（patiromer）与环硅酸锆钠（Sodium Zirconium Cyclosilicate, ZS-9），有望在未来为这类高危患者带来新的治疗选择。