Multiple small intestinal ulcers associated with protein-losing enteropathy secondary to cholesterol crystal embolism:a case report
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- KAWAMURA Takuji
- Department of Gastroenterology, Kyoto Second Red Cross Hospital
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- AMAMIYA Kana
- Department of Gastroenterology, Kyoto Second Red Cross Hospital
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- WADA Hironori
- Department of Gastroenterology, Kyoto Second Red Cross Hospital
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- SHIRAKAWA Atsushi
- Department of Gastroenterology, Kyoto Second Red Cross Hospital
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- OKADA Yusuke
- Department of Gastroenterology, Kyoto Second Red Cross Hospital
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- MANDAI Koichiro
- Department of Gastroenterology, Kyoto Second Red Cross Hospital
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- MORITA Atsuhiro
- Department of Gastroenterology, Kyoto Second Red Cross Hospital
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- UNO Koji
- Department of Gastroenterology, Kyoto Second Red Cross Hospital
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- YASUDA Kenjiro
- Department of Gastroenterology, Kyoto Second Red Cross Hospital
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- KATSURA Kanade
- Department of Histopathology and Cytology, Kyoto Second Red Cross Hospital
Bibliographic Information
- Other Title
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- 蛋白漏出性胃腸症を契機に発見された，コレステロール塞栓症による小腸多発潰瘍の1例
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Abstract
<p>A 78-year-old man with hypertension, nephrosclerosis, and angina pectoris visited his family doctor with a history of fatigue and leg edema. He had a history of percutaneous coronary intervention 5 years prior, and was taking low-dose aspirin. Blood tests revealed hypoalbuminemia, gastrointestinal 99mTc-HSA scintigraphy was positive, and alpha-1 antitrypsin clearance was high;therefore, the hypoalbuminemia was thought to be secondary to a protein-losing enteropathy. A small bowel series revealed multiple, ring-shaped, longitudinal ulcers in the ileum. Balloon-assisted enteroscopy from the anus showed severe stenosis with an ileal ulcer. Since we were not able to diagnose the ulcers, mesalazine and supplemental nutritional care were provided. Four years after the hypoalbuminemia had been diagnosed, the patient died because of pulmonary congestion secondary to renal failure. An autopsy revealed severe atherosclerosis in his aorta and multiple cholesterol embolisms in his small intestine, kidney, stomach, colon, liver, and spleen. The multiple ulcers in the small intestine were thought to be caused by cholesterol crystal embolism, which should be considered in the differential diagnosis of small intestinal ulcers in elderly men or patients after cardiovascular intervention.</p>
Journal
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- Nippon Shokakibyo Gakkai Zasshi
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Nippon Shokakibyo Gakkai Zasshi 114 (8), 1436-1445, 2017
The Japanese Society of Gastroenterology