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A case of anastomotic stenosis of the small intestine caused by cholesterol crystal embolism

BACKGROUND: Cholesterol crystal embolism (CCE) is caused by small crystals of cholesterol dispersed from atherosclerotic plaques of the aorta. There is an increasing interest in CCE because of the increased use of endovascular treatments. Here, we report a rare case of intestinal stenosis caused by...

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Autores principales: Murono, Koji, Kawai, Kazushige, Hata, Keisuke, Emoto, Shigenobu, Kaneko, Manabu, Sasaki, Kazuhito, Nishikawa, Takeshi, Otani, Kensuke, Tanaka, Toshiaki, Ikemura, Masako, Nozawa, Hiroaki
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Springer Berlin Heidelberg 2018
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5884749/
https://www.ncbi.nlm.nih.gov/pubmed/29619591
http://dx.doi.org/10.1186/s40792-018-0442-3
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author Murono, Koji
Kawai, Kazushige
Hata, Keisuke
Emoto, Shigenobu
Kaneko, Manabu
Sasaki, Kazuhito
Nishikawa, Takeshi
Otani, Kensuke
Tanaka, Toshiaki
Ikemura, Masako
Nozawa, Hiroaki
author_facet Murono, Koji
Kawai, Kazushige
Hata, Keisuke
Emoto, Shigenobu
Kaneko, Manabu
Sasaki, Kazuhito
Nishikawa, Takeshi
Otani, Kensuke
Tanaka, Toshiaki
Ikemura, Masako
Nozawa, Hiroaki
author_sort Murono, Koji
collection PubMed
description BACKGROUND: Cholesterol crystal embolism (CCE) is caused by small crystals of cholesterol dispersed from atherosclerotic plaques of the aorta. There is an increasing interest in CCE because of the increased use of endovascular treatments. Here, we report a rare case of intestinal stenosis caused by CCE after functional end-to-end anastomosis (FEEA). To our knowledge, this is the first report of CCE causing such an anastomotic stenosis. CASE PRESENTATION: A 77-year-old male patient underwent laparoscopy-assisted low anterior resection and protective ileostomy for rectal carcinoid tumor. He was admitted to our hospital with ileus 1 year after stoma closure. Eosinophils and creatine kinase level were slightly elevated. Computed tomography revealed a stricture with thickened intestinal wall just distal to the anastomosis site of the ileostomy. The wall of the descending aorta appeared shaggy due to thrombosis. The patient underwent laparoscopic small-bowel resection because ileus reoccurred after any oral intake. Histopathological findings of the resected specimen showed fibrotic changes distal to the anastomosis site, and needle-shaped cholesterol embolus was observed in the submucosal layer. Thus, the stenosis was considered to be caused by CCE. CONCLUSION: This appears to be the first published report of stenosis due to CCE at such an anastomotic site. Intestinal CCE is difficult to diagnose preoperatively and is associated with poor prognosis. If eosinophilia is present or shaggy aorta is observed, CCE should be suspected to make correct diagnosis and prevent recurrence of CCE.
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spelling pubmed-58847492018-04-09 A case of anastomotic stenosis of the small intestine caused by cholesterol crystal embolism Murono, Koji Kawai, Kazushige Hata, Keisuke Emoto, Shigenobu Kaneko, Manabu Sasaki, Kazuhito Nishikawa, Takeshi Otani, Kensuke Tanaka, Toshiaki Ikemura, Masako Nozawa, Hiroaki Surg Case Rep Case Report BACKGROUND: Cholesterol crystal embolism (CCE) is caused by small crystals of cholesterol dispersed from atherosclerotic plaques of the aorta. There is an increasing interest in CCE because of the increased use of endovascular treatments. Here, we report a rare case of intestinal stenosis caused by CCE after functional end-to-end anastomosis (FEEA). To our knowledge, this is the first report of CCE causing such an anastomotic stenosis. CASE PRESENTATION: A 77-year-old male patient underwent laparoscopy-assisted low anterior resection and protective ileostomy for rectal carcinoid tumor. He was admitted to our hospital with ileus 1 year after stoma closure. Eosinophils and creatine kinase level were slightly elevated. Computed tomography revealed a stricture with thickened intestinal wall just distal to the anastomosis site of the ileostomy. The wall of the descending aorta appeared shaggy due to thrombosis. The patient underwent laparoscopic small-bowel resection because ileus reoccurred after any oral intake. Histopathological findings of the resected specimen showed fibrotic changes distal to the anastomosis site, and needle-shaped cholesterol embolus was observed in the submucosal layer. Thus, the stenosis was considered to be caused by CCE. CONCLUSION: This appears to be the first published report of stenosis due to CCE at such an anastomotic site. Intestinal CCE is difficult to diagnose preoperatively and is associated with poor prognosis. If eosinophilia is present or shaggy aorta is observed, CCE should be suspected to make correct diagnosis and prevent recurrence of CCE. Springer Berlin Heidelberg 2018-04-04 /pmc/articles/PMC5884749/ /pubmed/29619591 http://dx.doi.org/10.1186/s40792-018-0442-3 Text en © The Author(s). 2018 Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made.
spellingShingle Case Report
Murono, Koji
Kawai, Kazushige
Hata, Keisuke
Emoto, Shigenobu
Kaneko, Manabu
Sasaki, Kazuhito
Nishikawa, Takeshi
Otani, Kensuke
Tanaka, Toshiaki
Ikemura, Masako
Nozawa, Hiroaki
A case of anastomotic stenosis of the small intestine caused by cholesterol crystal embolism
title A case of anastomotic stenosis of the small intestine caused by cholesterol crystal embolism
title_full A case of anastomotic stenosis of the small intestine caused by cholesterol crystal embolism
title_fullStr A case of anastomotic stenosis of the small intestine caused by cholesterol crystal embolism
title_full_unstemmed A case of anastomotic stenosis of the small intestine caused by cholesterol crystal embolism
title_short A case of anastomotic stenosis of the small intestine caused by cholesterol crystal embolism
title_sort case of anastomotic stenosis of the small intestine caused by cholesterol crystal embolism
topic Case Report
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5884749/
https://www.ncbi.nlm.nih.gov/pubmed/29619591
http://dx.doi.org/10.1186/s40792-018-0442-3
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