A Case of Massive Portal Venous Gas Caused by Fatal Intestinal Infarction

Hepatic portal venous gas (HPVG), a rare radiologic finding, is associated in some cases with severe or lethal conditions requiring urgent surgical intervention. Computed tomography has recently demonstrated a wider range of clinical conditions associated with HPVG, some of which are benign and do not necessarily require surgery. However, HPVG remains an ominous sign in cases of bowel ischemia or necrosis. We report on a case of massive HPVG caused by a fatal intestinal infarction, which showed rapid disease progression, eventually resulting in death due to septic shock. The HPVG in this case was huge and could therefore be confused with an air-biliarygram.

Effect of Proton Pump Inhibitor and Clopidogrel Combination on the Outcome of Patients with Ischemic Heart Disease / 대한내과학회지

BACKGROUND/AIMS: It has recently been suggested that proton pump inhibitors (PPIs) might reduce the inhibitory effect of clopidogrel on platelet aggregation. Co-administration of a PPI and clopidogrel in patients with ischemic heart disease may thus alter clinical outcome. We investigated the effect of concomitant use of a PPI with clopidogrel in Korean patients with ischemic heart disease. METHODS: This is a retrospective cohort study of 99 patients with acute coronary syndrome taking clopidogrel and PPIs after discharge from CHA Bundang Medical Center between January 1, 2003, and December 31, 2007. The control group consisted of 99 patients who were matched for age and sex but were not taking PPIs. RESULTS: Patients who received clopidogrel plus PPI had a greater than two times higher risk of re-admission or death (adjusted hazard ratio 2.51; 95% confidence interval [CI] 1.43~4.40; p = 0.001) than those who received clopidogrel alone. Lansoprazole use was associated with an increased risk of re-admission or death (adjusted hazard ratio 2.66; 95% CI 1.45~4.89; p = 0.002). Combined period of administration or Helicobacter pylori infection did not affect the risk of re-admission or death. CONCLUSIONS: Particular attention should be paid when patients with ischemic heart disease are prescribed a combination of clopidogrel and a PPI, since this combination was associated with an elevated risk of re-admission or death.

Gastric Mucosal Hemorrhage in a Patient with Idiopathic Thrombocytopenic Purpura / 대한소화기내시경학회지

Idiopathic thrombocytopenic purpura (ITP) is an autoimmune condition in which antibodies react against platelets and cause platelet destruction and bleeding that rarely results in gastrointestinal bleeding. Even though it is still controversial, a recent study suggested that Helicobacter pylori is one of the causes of ITP, and that eradication of H. pylori may be helpful for improving platelet count. We report a case of isolated gastric mucosal hemorrhage not related to H. pylori infection in a patient with ITP. A gastric mucosal biopsy revealed mild lamina proprial edema and extravasated red blood cells but no evidence of vasculitis or inflammatory cell infiltration. Thrombocytopenia can lead to a gastric mucosal hemorrhage not related to an H. pylori infection when treating patients with ITP.