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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...
Autores principales: | , , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Springer Berlin Heidelberg
2018
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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. |
format | Online Article Text |
id | pubmed-5884749 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2018 |
publisher | Springer Berlin Heidelberg |
record_format | MEDLINE/PubMed |
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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