Advertisement

Diseases of the Colon & Rectum

, Volume 36, Issue 6, pp 607–609 | Cite as

Colonic necrosis following sodium polystyrene sulfonate (Kayexalate®)-sorbitol enema in a renal transplant patient

Report of a case and review of the literature
  • Thomas R. Scott
  • Scott M. Graham
  • Eugene J. Schweitzer
  • Stephen T. Bartlett
Case Report
  • 94 Downloads

Abstract

The authors present the case of a patient who developed near total colonic necrosis shortly after renal transplantation. The onset of symptoms was temporally related to the administration of sodium polystyrene (Kayexalate ® ;Sanofi Winthrop Pharmaceuticals, New York, NY)-sorbitol enemas for treatment of hyperkalemia. Three similar cases have been reported in the literature. The presence of uremia and the use of sorbitol appear to be common denominators in the pathophysiology of this complication. It is suggested that Kayexalate ® -sorbitol enemas be avoided in renal transplant patients.

Key words

Colitis Renal transplant Kayexalate® Sorbitol 

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. 1.
    Flanigan RC, Reckard CR, Lucas BA. Colonic complications of renal transplantation. J Urol 1988; 139:503–6.PubMedGoogle Scholar
  2. 2.
    Lillemoe KD, Romolo JL, Hamilton SR, Pennington LR, Burdick JF, Williams GM. Intestinal necrosis due to sodium polystyrene (Kayexalate) in sorbitol enemas: clinical and experimental support for the hypothesis. Surgery 1987;101:267–72.PubMedGoogle Scholar
  3. 3.
    Wootton FT, Rhodes DF, Lee WM, Fitts CT. Colonic necrosis with Kayexalate-sorbitol enemas after renal transplantation. Ann Intern Med 1989;111:947–9.PubMedGoogle Scholar
  4. 4.
    Komorowski RA, Cohen EB, Kaufmann HM, Adams MB. Gastrointestinal complications in renal transplant patients. Am J Clin Pathol 1986;86:161–7.PubMedGoogle Scholar
  5. 5.
    Stylianos S, Forde KA, Benvenisty AI, Hardy MA. Lower gastrointestinal hemorrhage in renal transplant recipients. Arch Surg 1988;123:739–44.PubMedGoogle Scholar
  6. 6.
    Bernstein WC, Nivatvongs S, Tallent MB. Colonic and rectal complications of kidney transplantation in man. Dis Colon Rectum 1973;16:255–65.PubMedGoogle Scholar
  7. 7.
    Penn I, Brettschneider L, Simpson K, Martin A, Starzl TE. Major colonic problems in human transplant recipients. Arch Surg 1970;100:61–5.PubMedGoogle Scholar
  8. 8.
    Misra MK, Pinkus GS, Birtch AG, Wilson RE. Major colonic diseases complicating renal transplantation. Surgery 1973;73:942–8.PubMedGoogle Scholar
  9. 9.
    Squiers EC, Pfaff WW, Patton PR, Howard RJ. Early post transplant colon perforation: does it remain a problem in the cyclosporine era? Transplant Proc 1991;23:1782–4.PubMedGoogle Scholar
  10. 10.
    Knechtle SJ, Bollinger RR. Perforation of the gastrointestinal tract following renal transplantation. Transplant Proc 1989;21:2143–4.PubMedGoogle Scholar
  11. 11.
    Church JM, Fazio VW, Braun WE, Novick AE, Stein-muller DR. Perforation of the colon in renal homograft recipients. A report of 11 cases and a review of the literature. Ann Surg 1986;203:69–76.PubMedGoogle Scholar
  12. 12.
    Pollak R, Hau T, Mozes MF. The spectrum of peritonitis in renal transplant recipients. Am Surg 1985;51:617–20.PubMedGoogle Scholar
  13. 13.
    Thompson WH, Seigler HF, Rice RP. Ileocolonic perforation: a complication following renal transplantation. Am J Roentgenol Rad Ther Nuc Med 1975;125:723–30.Google Scholar
  14. 14.
    Arvanitakis C, Malek G, Uehling D, Morrissey JF. Colonic complications after renal transplantation. Gastroenterology 1973:64:533–8.PubMedGoogle Scholar
  15. 15.
    Gomella LG, Gehrken GA, Hagihara PF, Flanigan RC. Ischemic colitis and immunosuppression: an experimental model. Dis Colon Rectum 1986;29:99–101.PubMedGoogle Scholar
  16. 16.
    Gomella LG, Flanigan RC, Hagihara PF, Lucas BA, McRoberts JW. The influence of uremia and immunosuppression on an animal model for ischemic colitis. Dis Colon Rectum 1986;29:724–7.PubMedGoogle Scholar

Copyright information

© American Society of Colon and Rectal Surgeons 1993

Authors and Affiliations

  • Thomas R. Scott
    • 1
  • Scott M. Graham
    • 1
  • Eugene J. Schweitzer
    • 1
  • Stephen T. Bartlett
    • 1
  1. 1.Department of Surgery, Sections of Surgical Endoscopy and TransplantationUniversity of Maryland School of MedicineBaltimore

Personalised recommendations