Sodium polystyrene sulfonate, or
Kayexalate, is an
ion-exchange resin used to treat
hyperkalemia. It is sometimes used with
sorbitol, an osmotic
laxative that prevents
constipation. Small and large bowel
necrosis and perforation due to
Kayexalate were previously reported. However, no previous cases of gastric perforation were described. We present a case of gastric perforation in a 48-year-old patient, with
chronic kidney disease (CKD), lung transplant under chronic
corticosteroids, and two previous Nissen fundoplications. He presented with sudden epigastralgia,
hematemesis and hemodynamic instability. Esophagogastroduodenoscopy was not able to localize the site of
bleeding. Surgical exploration revealed perforation of the lesser curvature of the stomach. Antrectomy with a
Billroth II reconstruction was performed. Pathological examination revealed no abnormalities except fibrinoleukocytic debris with
Kayexalate crystals in the gastric wall.
Kayexalate is believed to be a trigger for the gastric injury in a patient with tissues impaired by
corticosteroids, CKD and immunosuppressors.