Colonic necrosis and perforation following oral sodium polystyrene sulfonate (Resonium A®/Kayexalate®) in a burn patient

Colonic necrosis and perforation is rare in burn patients, however, it can lead to serious morbidity and mortality. Here we present a case of unexplained colonic necrosis and perforation in a 53-year-old woman with 25% total body surface area burns. No identifiable cause of bowel necrosis was found except for the presence of sodium polystyrene sulfonate (SPS) crystals in the inflammatory debris on histological examination. Colonic necrosis has been described in the literature following the administration of SPS in sorbitol for hyperkalaemia in uraemic patients. However, this condition has never been documented in any burn patients previously.