A CASE OF CHOLESTEROL EMBOLISM CAUSING MULTIPLE PERFORATIONS OF THE SMALL INTESTINE

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  • コレステロール結晶塞栓症による多発小腸穿孔の１例

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Abstract

We present a case of cholesterol embolism causing multiple perforations of the small intestine and peritonitis. The patient was a 76-year-old woman who had previous histories of hypertension, coronary artery bypass operation, hemodialysis for chronic renal failure, and grafting for an abdominal aortic aneurysm. Abdominal CT scan performed for the onset of abdominal pain and high fever showed intraabdominal free air. Surgery was performed with a diagnosis of gastrointestinal perforation, when multiple perforations were confirmed in the small intestine. Hence extended resection of the small intestine and formation of stoma at the small intestine were carried out. However, the patient died of rapid progress of hepatic failure, suture failure, and gastrointestinal bleeding after closure of the stoma. Pathological studies revealed cholesterol crystal in the small intestinal arteriolae and hepatic arteries that might cause small intestinal perforations and hepatic failure.<br> No radical therapies for cholesterol embolism have been established as yet, so that early diagnosis based on renal and dermal symptoms and prevention of the onset of the disease in other organs are necessary. In this country only four cases of the disease causing small intestinal perforation have been reported, in which those patients had a poor prognosis. We must pay special attention to gastrointestinal symptoms including abdominal pain and anal bleeding.

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