-Case Reports-

Successful Treatment of a Colonic Ulcer Penetrating the Urinary Bladder Caused by the Administration of Calcium Polystyrene Sulfonate and Sorbitol

Takeshi Shioya^1,2, Masanori Yoshino^1,2, Masao Ogata^1,2, Tetsuo Shibuya^1,2, Akira Tokunaga^1,2, Koshi Matsumoto³ and Takashi Tajiri¹

¹Surgery for Organ Function and Biological Regulation, Graduate School of Medicine, Nippon Medical School
²Institute of Gastroenterology, Nippon Medical School Musashi Kosugi Hospital
³Department of Pathology, Nippon Medical School Musashi Kosugi Hospital

A 77-year-old woman was urgently admitted for the treatment of diabetic ketoacidosis and a duodenal ulcer hemorrhage in March 1999. She had a history of diabetes and angina pectoris. After admission, she received oral calcium polystyrene sulfonate and sorbitol to treat hyperkalemia. Nine days later, severe abdominal pain developed. A colonoscopic examination revealed a sigmoid colonic ulcer and stenosis; the patient was treated conservatively. At a 1-year follow-up examination, the colonic stenosis was found have worsened; pneumaturia developed in January 2001. The patient was found to have a sigmoidovesical fistula and underwent sigmoidectomy and partial resection of the ileum and urinary bladder. The histological findings were a benign colonic ulcer with the infiltration of inflammatory cells, mainly lymphocytes. Rhomboidal, dark violet Kayexalate^® crystals were observed on microscope examination in the submucosa in both the first and second colonic biopsy specimens. We concluded that the colonic ulcer and the sigmoidovesical fistula had been caused by the administration of calcium polystyrene sulfonate and sorbitol. Reports of colonic perforation as a result of the administration of calcium polystyrene sulfonate and sorbitol are rare. Here, we report the successful treatment of a colonic ulcer that had penetrated the urinary bladder.

J Nippon Med Sch 2007; 74: 359-363

Keywords
calcium polystyrene sulfonate, Kayexalate^® crystal, colonic ulcer

Correspondence to
Takeshi Shioya, MD, Institute of Gastroenterology, Nippon Medical School Musashi Kosugi Hospital, 1-396 Kosugi-cho, Nakahara-ku, Kawasaki, Kanagawa 211-8533, Japan
shioya@nms.ac.jp

Received, March 26, 2007
Accepted, June 11, 2007