Multiple spontaneous intestinal perforations from atheroembolism after thrombolytic therapy: a case report

Atheroembolism after thrombolytic therapy, although rare, is unpredictable and carries a poor prognosis. Early diagnosis is difficult because 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, progressive renal failure and peripheral ischemia. At laparotomy performed when the peritoneal dialysate was found to contain enteric contents, numerous ischemic small-bowel infarcts were seen, many of which had perforated. The entire intestine was involved, and despite efforts to repair the perforations, the patient had a downhill course and died 44 days after admission to hospital. In patients with disseminated atheroembolism after thrombolytic therapy, supportive care is the only treatment 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 atheroembolism as a result of thrombolytic therapy.