Gastrointestinal blood loss due to cholesterol crystal embolization

Gastrointestinal blood loss in elderly atherosclerotic patients may be due to cholesterol crystal embolization (CCE) leading to ischemic lesions in the gastrointestinal tract. The diagnosis of CCE is favored by accompanying clinical or biochemical signs, such as blue toes, renal insufficiency, and eosinophilia. Our report describes the clinical data of four patients with gastrointestinal blood loss due to CCE. In two the bleeding source was in the duodenum, and in the other two the source was in the distal colon. The diagnosis was made by histological examination of endoscopic biopsies in three and of a sigmoid resection specimen in one. Provoking factors were anticoagulant therapy in one, anticoagulant therapy and aortography in another, and aortography followed by aorta bifurcation prosthesis implantation in the third, whereas no provoking factor could be identified in the remaining patient. Accompanying signs included eosinophilia in one, a blue toe with renal insufficiency in one, and retinal cholesterol crystals in another patient. Our findings, in line with previous reports, highlight the importance of CCE in the differential diagnosis of gastrointestinal blood loss in elderly patients.