Perforation of the small bowel: a case report

Nontraumatic perforation of the small bowel is rare. A 71-year-old man presented with a perforated jejunum 8 weeks after receiving streptokinase therapy for acute myocardial infarction. This was complicated by a bleeding duodenal ulcer, renal failure, ischemia of one toe and confusion. Renal biopsy showed cholesterol emboli. Examination of the resected specimen of jejunum revealed multiple cholesterol emboli but no other disorder. Cholesterol embolization has been associated with angiography, vascular surgery and thrombolytic therapy for myocardial infarction. Acute renal failure and ischemia of the digits as seen in this patient is also a common presentation of cholesterol embolization syndrome.