A 46-year-old fully active, asymptomatic man suffered two episodes of major peripheral arterial embolism within 2 months. Heart disease was ruled out by appropriate investigations. Further diagnostic evaluation (angiography, CAT scan) revealed the extremely rare finding of a "floating mass" in the transverse aortic arch suspected to be the source of embolization. This mass was successfully removed using the technique of hypothermic cardiocirculatory arrest. The histological diagnosis was an aged intraluminal thrombus and moderate atherosclerosis of the thoracic aorta. For prevention of recurrent arterial embolism in cases without an initially apparent cause and site of origin, a thorough diagnostic, and in a given patient, an aggressive surgical approach for the elimination of the embolic source are advocated.

Background: A spontaneous perforation in the area of the small intestine, in particular of the jejunum, is an absolute rarity. It can occur after a sprue or an unspecific jejunitis or ileitis as well as with leukaemia, metastases and with a specific illness, the extranodale enteropathy-associated malignant non-Hodgkin’s lymphoma of the small intestine. Patients and Methods: During the period of 12 years a total of 4 patients, whose symptoms and clinical course were typical of this illness, were treated in our hospital. In one of the patients a malignant histiocytosis was diagnosed, that corresponds to an outdated definition and has to be assigned to the malignant lymphoma as an independent entity. The very typical course of a patient’s illness is described in detail. Results: All patients showed a typical course of their illness. A prominent feature was the rate of perforation in the area of the small intestine, particularly of the jejunum, which was combined with a malabsorption syndrome. Conclusion: A spontaneous perforation of the small intestine leads one to assume that a malignant extranodale non-Hodgkin’s lymphoma may be present. The preceding clinical results mostly give the impression of a malabsorption syndrome. The surgical treatment is the resection of the perforated part of the small intestine, as the danger of recurrence is very high.

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