Skip to main content
SpringerLink
Log in

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

Report of a case and review of the literature

  • Case Report
  • Published:
Diseases of the Colon & Rectum

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.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Flanigan RC, Reckard CR, Lucas BA. Colonic complications of renal transplantation. J Urol 1988; 139:503–6.

    PubMed  Google Scholar 

  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.

    PubMed  Google Scholar 

  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.

    PubMed  Google Scholar 

  4. Komorowski RA, Cohen EB, Kaufmann HM, Adams MB. Gastrointestinal complications in renal transplant patients. Am J Clin Pathol 1986;86:161–7.

    PubMed  Google Scholar 

  5. Stylianos S, Forde KA, Benvenisty AI, Hardy MA. Lower gastrointestinal hemorrhage in renal transplant recipients. Arch Surg 1988;123:739–44.

    PubMed  Google Scholar 

  6. Bernstein WC, Nivatvongs S, Tallent MB. Colonic and rectal complications of kidney transplantation in man. Dis Colon Rectum 1973;16:255–65.

    PubMed  Google Scholar 

  7. Penn I, Brettschneider L, Simpson K, Martin A, Starzl TE. Major colonic problems in human transplant recipients. Arch Surg 1970;100:61–5.

    PubMed  Google Scholar 

  8. Misra MK, Pinkus GS, Birtch AG, Wilson RE. Major colonic diseases complicating renal transplantation. Surgery 1973;73:942–8.

    PubMed  Google Scholar 

  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.

    PubMed  Google Scholar 

  10. Knechtle SJ, Bollinger RR. Perforation of the gastrointestinal tract following renal transplantation. Transplant Proc 1989;21:2143–4.

    PubMed  Google Scholar 

  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.

    PubMed  Google Scholar 

  12. Pollak R, Hau T, Mozes MF. The spectrum of peritonitis in renal transplant recipients. Am Surg 1985;51:617–20.

    PubMed  Google Scholar 

  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. Arvanitakis C, Malek G, Uehling D, Morrissey JF. Colonic complications after renal transplantation. Gastroenterology 1973:64:533–8.

    PubMed  Google Scholar 

  15. Gomella LG, Gehrken GA, Hagihara PF, Flanigan RC. Ischemic colitis and immunosuppression: an experimental model. Dis Colon Rectum 1986;29:99–101.

    PubMed  Google Scholar 

  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.

    PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Surgery, Sections of Surgical Endoscopy and Transplantation, University of Maryland School of Medicine, Baltimore, Maryland

    Thomas R. Scott M.D., Scott M. Graham M.D., Eugene J. Schweitzer M.D. & Stephen T. Bartlett M.D.

Authors
  1. Thomas R. Scott M.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Scott M. Graham M.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Eugene J. Schweitzer M.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Stephen T. Bartlett M.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

About this article

Cite this article

Scott, T.R., Graham, S.M., Schweitzer, E.J. et al. Colonic necrosis following sodium polystyrene sulfonate (Kayexalate®)-sorbitol enema in a renal transplant patient. Dis Colon Rectum 36, 607–609 (1993). https://doi.org/10.1007/BF02049870

Download citation

  • Issue Date:

  • DOI: https://doi.org/10.1007/BF02049870

Key words

Search

Navigation