A Case of Multiple Ileal Necrosis Caused by Cholesterol Crystal Embolism

Abstract

A 70-year-old male patient with a history of hypertension and diabetes mellitus was admitted to our hospital with abdominal pain and diarrhea. Five days prior to his admission to our hospital, he was diagnosed as having enteritis at another facility; however, he was referred to our hospital when his symptoms failed to improve and he developed dysphagia. Abdominal CT revealed ileal wall thinning, impaired blood flow, and proximal intestinal dilatation, raising the suspicion of small bowel necrosis. Emergency surgery was performed, which confirmed the presence of circumferential necrosis of the ileum and intermittent partial necrosis in adjacent areas. Resection of a 20-cm segment of the ileum was performed, with end-to-end anastomosis. The patient progressed favorably and was discharged on the 13th day of hospitalization. Pathological examination of the resected specimen revealed thromboembolism with cholesterol crystals. This condition is typically characterized by cholesterol crystals embolizing into small arteries following the rupture of atherosclerotic plaques in the aorta or large vessels, leading to systemic multi-organ failure. Small bowel perforation is rare. We report this case of small bowel perforation occurring without obvious precipitating factors, along with a review of the literature.