5)コレステロール結晶塞栓症

Gastrointestinal Tract Involvement in Cholesterol Crystal Embolization

　コレステロール結晶塞栓症は動脈硬化性の基礎疾患を有する高齢者における抗凝固療法や血管内カテーテル操作を誘因として発生する全身性微小塞栓症で，皮膚，腎，膵などの多臓器障害が認められる．本症における消化管病変の記載は比較的少ないが，自験例では胃・十二指腸および遠位大腸の点状ないし面状発赤，びらん，アフタ様病変などの比較的軽微な所見が認められた．一方，出血や穿孔などの重篤な消化管病変を来した症例の報告も散見される．したがって，本症では全身性塞栓の一部分症として消化管病変が発生しうることを念頭に置く必要がある．

　Cholesterol crystal embolization (CCE) is a rare disease mainly caused by anti-coagulant therapy or arterial manipulation in patients with atherosclerosis. In CCE, microemboli of showered cholesterol crystals leads to multisystem disorders including the skin, kidney, pancreas and gastrointestinal tract. Although endoscopic findings of CCE have been only rarely reported, spotty erythema, erosions, and ulcerations have been observed in patients with the disease. It has also been reported that CCE causes fatal gastrointestinal complications, such as massive hemorrhage, necrosis and perforation. It thus seems necessary to take this disease into consideration when an atherosclerotic patient complains of abdominal symptoms.