چکیده (انگلیسی):

Introduction: Sevelamer is an anion exchange resin used to treat hyperphosphatemia. A common adverse
effect of sevelamer is constipation. According to a review of the available literature, colon perforation
associated with this resin agent was less common.
Presentation of case: A 66-year-old man complaining of lower abdominal pain was transferred to our
hospital. The patient had been undergoing hemodialysis for chronic renal failure due to rapidly progressive
glomerulonephritis, and had been receiving sevelamer hydrochloride 4.5 g/day for 8years as
treatment for hyperphosphatemia. Abdominal computed tomography revealed ascites, free air in the
abdominal cavity, multiple diverticula of the sigmoid colon, as well as increased fat tissue surrounding
the sigmoid colon. We diagnosed colonic perforation and performed emergency surgery, which revealed
a 5 5 mm perforation in the sigmoid colon surrounded with soft stool. Histopathologically, sevelamer
crystals were detected at the perforation site.
Discussion: We theorize that physical stimulation by sevelamer crystals contributed to colon perforation
at the already vulnerable diverticulum site.
Conclusion: When sevelamer is administered to patients with hemodialysis, the risk of intestinal
perforation should be considered.