title: A case of repeated small bowel perforations in a short period in a patient with cholesterol crystal embolism.
abstract: We report a case of jejunal perforation related to cholesterol crystal embolism (CCE) in a woman in her seventies. The jejunum was partially resected;histological examination of the resected tissue revealed that the perforation was caused by CCE. On postoperative day 12, computed tomography (CT) showed free air in the abdomen. We then performed a second operation to alleviate the anastomotic leakage. Subsequently, 26 days after the second surgery, CT again showed free air in the abdomen. A third operation was performed, and multiple perforations of the jejunum were detected. She died of multiple organ failure 43 days after the first surgery. The prognosis of CCE with gastrointestinal perforation is reported to beextremely poor, and there is a high rate of anastomotic leakage. Partial resection of the intestine and ileostomy might be useful for removing the intestinal perforations caused by a CCE. Steroid administration should be continued, however, because discontinuation may worsen the problem.
authors.affiliation: Department of Gastrointestinal and Hepato-Biliary-Pancreatic Surgery, Nippon Medical School.
authors.forename: Eriko
authors.initials: E
authors.lastname: Shinozuka
authors.forename: Takeshi
authors.initials: T
authors.lastname: Yamada
authors.forename: Hayato
authors.initials: H
authors.lastname: Kan
authors.forename: Satoshi
authors.initials: S
authors.lastname: Matsumoto
authors.forename: Michihiro
authors.initials: M
authors.lastname: Koizumi
authors.forename: Seiichi
authors.initials: S
authors.lastname: Shinji
authors.forename: Hiroki
authors.initials: H
authors.lastname: Arai
authors.forename: Zenya
authors.initials: Z
authors.lastname: Naito
authors.forename: Eiji
authors.initials: E
authors.lastname: Uchida
mesh_terms: D000368:Aged; D003460:Crystallization; D017700:Embolism, Cholesterol / Q000150:complications*; D005260:Female; D006801:Humans; D007416:Intestinal Perforation / Q000209:etiology*; D007579:Jejunal Diseases / Q000209:etiology*