Hyperkalaemia as a complication of ureteroileostomy: a case report and literature review

Abstract

Ureteral diversion in which the ureter is implanted into either the sigmoid colon or a short loop of ileum is associated with multiple metabolic complications [1,2]. Ureterosigmoidostomy commonly leads to metabolic acidosis due to the presence of colonic anion exchange pumps that reabsorb luminal chloride as bicarbonate is secreted across the sigmoid colon. In such cases, reabsorption of urinary ammonium that contacts the sigmoid colon may also contribute to metabolic acidosis [1]. In addition, sigmoid loops usually lead to hypokalaemia due to colonic potassium secretion. However, if the intestinal conduit in contact with ureteral contents is jejunum, hyperkalaemia may occur, presumably due to absorption of urinary potassium by the jejunum. This infrequent complication of ureteral diversion has been rarely reported but should be considered in cases of hyperkalaemia in patients with ureteroiliostomies. In such cases, jejunal contact with the ureteral drainage likely is occurring and resulting in hyperkalaemia via jejunal absorption of potassium. We report an illustrative case in which enteral feeding repeatedly resulted in hyperkalaemia in a patient who underwent urinary diversion with a conduit assumed to be implanted in the low ileum.