Abstract
A 72-year-old man with a previous history of percutaneous coronary intervention, coronary artery bypass surgery, aortic valve replacement, and laparoscopy assisted distal gastrectomy, developed abdominal pain after dinner and was admitted to our hospital. An abdominal computed tomography (CT) scan revealed intra-abdominal free air and ascites. The patient was thus diagnosed as having gastrointestinal perforation and underwent partial resection of the small intestine to treat the small intestinal perforation. A histopathological examination indicated that the small intestinal perforation was caused by cholesterol crystal embolization (CCE). The patient was discharged but readmitted to our hospital 7 days later due to abdominal pain. Free air and ascites were again noted on a CT scan, and the patient was again diagnosed with a gastrointestinal perforation, which was treated with another partial resection of the small intestine. However, he died 28 days postoperatively because of an anastomotic leak or a new perforation. Histopathological findings again revealed cholesterol crystals in the resected small intestine. CCE is a disease with poor prognosis that is caused by the release of cholesterol crystals from atherosclerotic plaques. We should be aware of the possibility of CCE when we encounter a patient with an acute abdomen.
