2017 Volume 37 Issue 3 Pages 497-501
An 87-year-old woman was admitted to our hospital because of acute heart failure and the exacerbation of chronic renal failure 3 months previously. She was found to have stenotic lesions in her coronary arteries, so a percutaneous coronary angioplasty was performed and anticoagulant therapy was started. Hemodialysis was also initiated for chronic renal failure. She was discharged 2 weeks later but was readmitted to our hospital with abdominal pain. An abdominal computed tomography scan showed free air and ascites. She was diagnosed as having a gastrointestinal perforation and an emergency operation was performed. Two sites of perforation and multiple ulcers were identified in the small intestine, and a partial resection of the small intestine was completed. On postoperative day 4, we histologically diagnosed the patient as having perforations of small intestinal ulcers caused by cholesterol crystal embolization (CCE). The next day, we performed low-density lipoprotein apheresis (LDL-A) and started steroid pulse therapy. The skin lesions associated with CCE improved temporarily, but she died on postoperative day 16 because of an anastomotic leak or a new perforation.
