Warfarin-induced Mesenteric Bleeding and Small Bowel Necrosis

Oral anticoagulants are used for prophylaxis or treatment of both arterial and venous thromboembolisms, and their use has increased with the increment of the aged population and cardiovascular disease. Oral anticoagulants, such as warfarin, are associated with a risk for bleeding, but small bowel necrosis by hemorrhage is a very rare complication of warfarin therapy. The combination of warfarin and an antiplatelet agent increase the risk of bleeding. A 70-year-old man with no prior symptoms was admitted to the emergency department with periumbilical pain. He had been taking warfarin and aspirin due to valve replacement therapy. He underwent an exploratory laparotomy due to sustained abdominal pain and fever. A macroscopic examination of the resected jejunum showed transmural hemorrhagic necrosis. We report a rare case of small bowel necrosis as a complication of warfarin therapy.

Intake Increased the GallStone Formation in Guinea Pigs Due to High Oral Calcium Intake

Oral calcium supplementation has been recommended for prevention of osteoporosis in postmenopausal women. However experimental studies have suggested that oral calcium supplementation may increase the biliary calcium concentration and the incidence of gallstone formation in some animals. We designed an experiment to establish the effect of oral calcium supplementation in Guinea pigs. Nineteen Guinea pigs were divided into 2 groups. Group I (n=10) was fed with normal water, and group II (n=9) was fed with calcium-containing water(oscal 1000 mg/250 ml normal water). After 6 weeks, all animal were sacrifised, and the presence of gallstones was examined by inspection. Gallbladder bile and blood also were sampled. Gallstones were not found in group I, but in group II, gallstones were observed in five animals (56%). The level of calcium, bile acid, phospholipid, cholesterol, and bilirubin in the gallbladder bile was the same for both group I and group II. The levels of calcium and cholesterol in the serum was also the same for these two groups, but the level of bilirubin was remarkably lower group II than in group I. Oral calcium supplementation increased gallstone formation in guinea pigs, but there was no difference in the level of calcium in the bile composition. This present study could not confirm that oral calcium supplementation increased biliary calcium and then the incidence of gallstone formation in Guinea pigs. We think that the increase of biliary calcium after oral calcium supplementation is not the sole fator in gallstone formation and that other factors may be involved.

Intake Increased the GallStone Formation in Guinea Pigs Due to High Oral Calcium Intake

Oral calcium supplementation has been recommended for prevention of osteoporosis in postmenopausal women. However experimental studies have suggested that oral calcium supplementation may increase the biliary calcium concentration and the incidence of gallstone formation in some animals. We designed an experiment to establish the effect of oral calcium supplementation in Guinea pigs. Nineteen Guinea pigs were divided into 2 groups. Group I (n=10) was fed with normal water, and group II (n=9) was fed with calcium-containing water(oscal 1000 mg/250 ml normal water). After 6 weeks, all animal were sacrifised, and the presence of gallstones was examined by inspection. Gallbladder bile and blood also were sampled. Gallstones were not found in group I, but in group II, gallstones were observed in five animals (56%). The level of calcium, bile acid, phospholipid, cholesterol, and bilirubin in the gallbladder bile was the same for both group I and group II. The levels of calcium and cholesterol in the serum was also the same for these two groups, but the level of bilirubin was remarkably lower group II than in group I. Oral calcium supplementation increased gallstone formation in guinea pigs, but there was no difference in the level of calcium in the bile composition. This present study could not confirm that oral calcium supplementation increased biliary calcium and then the incidence of gallstone formation in Guinea pigs. We think that the increase of biliary calcium after oral calcium supplementation is not the sole fator in gallstone formation and that other factors may be involved.

A Case of a Pseudoaneurysm in Chronic Pancreatitis / 대한소화기내시경학회지

The bleeding pseudoaneurysm is a rare condition but one of the lethal complications in patients with chronic pancreatitis. Early diagnosis and emergent intervention can reduce mortality and promise better outcomes. We experienced a case of a bleeding pseudo- aneurysm in a chronic pancreatitis patient. The 44-year-old male was suffering from con- tinuous, vague epigastric pain and black tarry stool. An abdominal CT scan revealed a homogeneously enhancing round mass in the pancreatic pseudocyst, and celiac angi- ography found that a pseudoaneurysm had originated from the pancreaticoduodenal artery. The patient was treated with Whipple's operation and was later discharged, having improved in his condition.