Bowel perforation complicating sodium polystyrene sulfonate (Kayexalate®) therapy

Bowel perforation is an uncommon complication of the administration of sodium polystirene sulfonate. We describe a case of bowel perforation occurring soon after the performance of a right colectomy in a patient with stage 3 chronic renal failure treated with sodium polystyrene sulfonate. The perforation was revealed during the course of revision surgery. Histological examination demonstrated perivisceritis with ischemic wall damage and hemorrhagic mucosa filled with numerous blackish, sharp-angled crystalloids. After reviewing the literature concerning the complications associated with the administration of SPS, we discuss some aspects of professional medical liability with particular reference to the etiopathogenesis of bowel perforation.