A Case of Multiple Small Intestinal Perforations Caused by Cholesterol Crystal Embolization

Abstract

An 88-year-old woman was referred to our hospital after computed tomography for the investigation of abdominal pain and distension showed free air within the abdominal cavity. Gastrointestinal perforation was diagnosed, and emergency surgery was performed. Intraoperatively, multiple small intestinal perforations were identified, and partial ileectomy was performed. Postoperatively, the patient developed peritonitis due to recurrent perforation and anastomotic leakage, and he died on postoperative day 9. The postoperative histopathological diagnosis was small intestinal perforations caused by cholesterol crystal embolization. Cholesterol crystal embolization is a condition involving generalized microemboli that are usually caused by factors including major vessel surgery, endovascular catheterization, and anticoagulant therapy, but it is rare for this to cause small intestinal perforation. A case of multiple small intestinal perforations caused by cholesterol crystal embolization with no obvious cause is reported, together with a discussion of the literature.