Key result
Cardiovascular interventions are linked to fatal recurrent intestinal perforations driven by cholesterol crystal embolization.
Why the study?
Cholesterol crystal embolization (CCE) causes multi-organ damage with poor prognosis and can lead to recurrent intestinal perforations, but its role in acute abdominal conditions is not well recognized.
Case Report (n=1)
Cholesterol crystal embolization should be considered as a potential cause of acute abdomen and recurrent intestinal perforations in patients with severe atherosclerotic disease.
Alerts clinicians to cholesterol embolization risk in recurrent perforations post-intervention; leaves open preventive strategies.
症例は72歳，男性．経皮的冠動脈形成術，冠動脈バイパス術と大動脈弁置換術の治療歴を有し，胃癌に対して腹腔鏡補助下胃全摘術施行後であった．食後より腹痛が出現し，当院を受診．腹膜刺激症状を認め，CTで遊離ガスと腹水を認めたため消化管穿孔と診断し手術を行った．小腸に穿孔を認め，病理組織所見でコレステロール結晶塞栓症（cholesterol crystal embolization:CCE）による小腸穿孔と診断した．術後は良好に経過し，退院するも退院後7日目に再度腹痛が出現し再入院となり消化管穿孔のため再手術を行った．小腸再穿孔を認めたため小腸切除を行ったが，術後再穿孔もしくは縫合不全をきたし再手術後28日目に死亡した．病理所見で前回同様CCEを認めた．CCEは血管内粥腫の破綻，飛散により多臓器障害をきたす予後不良な疾患であり，急性腹症の診療の際は本症の可能性も考慮する必要があると考えられた．
No takes yet. Share an insight, caveat, or question.
Shouji et al. (2013) conducted a case report in Recurrent intestinal perforations caused by cholesterol crystal embolization (n=1). Partial resection of the small intestine was evaluated. A 71-year-old man with a history of cardiovascular interventions developed recurrent intestinal perforations due to cholesterol crystal embolization and died 14 days after a second surgery.
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: