CHOLESTEROL CRYSTAL EMBOLIZATION TO THE ALIMENTARY-TRACT

The features of cholesterol crystal embolisation (CCE) to the alimenta ry tract were studied by retrospective analysis of the clinical and pa thological data of 96 patients (70 men, 26 women, mean age 73.8 (58-95 ) years) with this diagnosis in the Dutch national pathology informati on system (Pathologisch Anatomisch Landelijk Geautomatiseerd Archief ( PALGA)) from 1973-92. In the 96 patients, 130 CCE sites were found thr oughout the alimentary tract, mostly in the colon (42.3%). Most patien ts had a history of atherosclerotic disease and presented with abdomin al pain, diarrhoea, or gastrointestinal bleeding, sometimes after surg ical or radiological vascular procedures. A number were taking oral an ticoagulant treatment. The diagnosis of CCE had been considered before the histological diagnosis in only 11 patients. In the remaining case s, ischaemic colitis, tumour, and inflammatory bowel disease were sugg ested in the differential diagnosis. A premortem diagnosis of CCE was made in 70.8% of the cases. In 24 ofthe 35 necropsy examinations, CCE seemed to be directly or indirectly related to the cause of death. It is concluded that in this unselected, homogenous group of patients, CC E sites were most frequently found in the colon. They generally presen ted with abdominal pain, diarrhoea, and gastrointestinal blood loss. C CE often mimicked common gastrointestinal disease, leading to incorrec t diagnosis.