SHM Converge Scientific Abstract ePoster Gallery-Refractory Colonic Pseudo-Obstruction With Severe Hypokalemia Resolved by Sigmoidectomy

Pdf Summary

A 58-year-old man with hypertension, hyperlipidemia, type 2 diabetes, and stage 3 chronic kidney disease presented with 3 weeks of weakness, dyspnea, and bilateral leg edema. Examination showed anasarca, with albumin 1.8 g/dL and CT imaging revealing ascites and a markedly dilated sigmoid colon. He was admitted for evaluation of edema and bowel dilation.<br /><br />His course was notable for refractory secretory diarrhea-associated colonic pseudo-obstruction (SD-CPO), an uncommon form of acute colonic pseudo-obstruction that can cause profound potassium wasting and severe electrolyte disturbances. Initial management with bowel rest, decompression, neostigmine, and repeated endoscopic decompression led only to transient improvement. He developed persistent small-volume diarrhea, worsening hypokalemia to 2.2 mEq/L, non-anion gap metabolic acidosis, and required up to 260 mEq of potassium replacement daily to maintain potassium around 2.7 mEq/L. Urinary potassium was low, suggesting extrarenal losses. Workup did not reveal heart failure, cirrhosis, or oliguric renal failure; kidney biopsy showed chronic diabetic and hypertensive changes.<br /><br />The presumed mechanism was upregulation of colonic potassium channels, especially BK channels, likely accentuated by chronic kidney disease, shifting potassium excretion from the kidneys to the colon. Despite temporary improvement after decompression, the sigmoid colon again dilated to 20 cm and conservative measures failed.<br /><br />Ultimately, elective sigmoidectomy with Hartmann’s pouch was performed. After surgery, the patient tolerated a normal diet, developed formed stools, and his electrolyte abnormalities resolved within 2 weeks. He was discharged to acute rehabilitation on hospital day 53.<br /><br />This case highlights SD-CPO as a rare but important cause of refractory hypokalemia, particularly in patients with CKD. When standard medical and endoscopic therapy fails, surgical resection can be curative.

Asset Subtitle

Alexia R. Jauregui

Meta Tag

Author List Alexia R. Jauregui, Carissa Huq, Jillian L. Smith

Category Clinical Vignettes

Concept Secretory Diarrhea-Associated Colonic Pseudo-Obstruction

Concept Pseudo-Obstruction

Concept Hypokalemia

Concept Diarrhea

Concept Colonic Distention

Distinguished Non-Finalist

Presenter Organization The University of Texas at Houston Health Sciences Center

Presenting Author Alexia R. Jauregui

Track Adult

Keywords

secretory diarrhea-associated colonic pseudo-obstruction

refractory hypokalemia

chronic kidney disease

sigmoid colon dilation

acute colonic pseudo-obstruction

potassium wasting

neostigmine

endoscopic decompression

sigmoidectomy

Hartmann's pouch

Secretory Diarrhea-Associated Colonic Pseudo-Obstruction

Pseudo-Obstruction

Hypokalemia

Diarrhea

Colonic Distention