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Small bowel (small intestine)

Benign tumors and tumor-like conditions

Kayexelate damage

Reviewer: Hanni Gulwani, M.D. (see Reviewers page)
Revised: 22 December 2012, last major update August 2012
Copyright: (c) 2003-2012, PathologyOutlines.com, Inc.


● Kayexelate (sodium polystyrene sulfonate) in sorbitol is used to treat hyperkalemia, but may crystallize in small intestine (also elsewhere in GI tract) and produce endoscopic findings resembling ulcer or erosion (Am J Surg Pathol 2001;25:637)
● Also causes intestinal necrosis (South Med J 2009;102:493, Hum Pathol 2007;38:527)

Case reports

● 87 year old man (Case Rep Gastroenterol 2007;1:144)

Micro description

● Crystals are lightly basophilic with a faint crystalline mosaic pattern, better seen with PAS/Alcian blue
● Crystals are refractile but not polarizable, luminal and adherent to intact surface epithelium or mixed with inflammatory exudates in patients with ulcer or erosion

Micro images

Various images

Figure a-Kayexalate crystals are variable sizes, all showing a mosaic “cracking” pattern; patient had severe cardiovascular compromise and received kayexalate for hypokalemia; bowel was necrotic and ischemic
Figure b-Cholestyramine crystals resemble kayexalate, but are red; larger cyrstals show some mosaic “cracking,” but smaller cholestyramine crystals do not

End of Small bowel (small intestine) > Benign tumors and tumor-like conditions > Kayexelate damage

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