Abstract
Cholesterol crystal embolization (CCE) is a rare systemic atheroembolism caused by showers of cholesterol crystals from a ruptured atherosclerotic plaque.
A 77-year-old man was brought into our hospital because of severe abdominal pain. He had peritoneal sign. Abdominal CT scan showed free air and ascites. Gastrointestinal perforation was diagnosed and an emergency operation was performed. Three perforated sites were identified in the small intestine, and partial resection of the small intestine was carried out. From histopathological findings, we diagnosed the case as multiple perforations of small bowel ulcers caused by CCE. On the third postoperative day, a black discharge was drained from a gastric tube. Upper gastrointestinal endoscopy disclosed further multiple ulcers in the stomach and duodenum. On the fourth postoperative day, an intestinal juice like discharge appeared, suggesting another perforation of the small bowel might occur. As the patient had had unconsciousness and status epilepticus after the operation and a CT scan of the head confirmed multiple cerebral infarctions, we had to give up re-laparotomy. The patient died on the eighth postoperative day.
CCE presents with impaired renal function, skin and gastrointestinal symptoms, however, it rarely causes gastrointestinal perforation. We present previously reported cases, including our case, of gastrointestinal perforation caused by CCE.
