MULTIPLE SPONTANEOUS INTESTINAL PERFORATIONS FROM ATHEROEMBOLI AFTER THROMBOLYTIC THERAPY - A CASE-REPORT

Atheroembolism after thrombolytic therapy, although rare, is unpredict able and carries a poor prognosis. Early diagnosis is difficult becaus e of the many forms of presentation. A 76-year-old man with no history of atheromatous disease, who had received streptokinase as treatment for myocardial infarction, had lower gastrointestinal bleeding, progre ssive renal failure and peripheral ischemia. At laparotomy performed w hen the peritoneal dialysate was found to contain enteric contents, nu merous ischemic small-bowel infarcts were seen, many of which had perf orated. The entire intestine was involved, and despite efforts to repa ir the perforations, the patient had a downhill course and died 44 day s after admission to hospital. In patients with disseminated atheroemb olism after thrombolytic therapy, supportive care is the only treatmen t currently available. As thrombolytic therapy becomes more common in the treatment of myocardial infarction, greater effort will be needed to provide better treatment for patients with disseminated atheroembol ism as a result of thrombolytic therapy.