A Case of Colon Necrosis due to Cholesterol Crystal Embolism

Abstract

A 55-year-old man presented with sudden abdominal pain a few hours after coronary angiography with a Swan-Ganz catheter at our hospital. His abdominal pain was mild, and he was treated conservatively, but the next day, his abdominal pain worsened, and he had rebound tenderness. Contrast-enhanced abdominal computed tomography showed portal vein gas, poor contrast of the ascending colon wall, and an edematous transverse colon, although the contrast effect of the mucosa was preserved. Emergency surgery was performed with the diagnosis of necrosis of the ascending colon. At surgery, necrosis was observed in the ascending colon, but the serosa of the transverse colon was intact. Intraoperative indocyanine green was used to determine the extent of resection. Extended right hemicolectomy of the colon was performed. Postoperative pathological examination showed necrosis of the colon due to cholesterol embolism. The patient was transferred to the Department of Cardiology on the 8th postoperative day and discharged on the 19th postoperative day. A rare case of necrosis of the colon due to cholesterol embolism is reported.