Minerva

doi:10.1136/bmj.327.7410.350

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Concern about the one million unplanned pregnancies a year in the United States has led to efforts being made to make emergency contraception more easily available—which means without a prescription. Some articles in Obstetrics and Gynecology (2003; 102: 8-16) argue forcefully that women are more likely to use emergency contraception if they have a supply in the house. One useful initiative is to give a supply of the pills and some “appropriate education” to women shortly after they have given birth.

A 51 year old man presented to the accident and emergency department with a 12 hour history of diarrhoea and vomiting after eating a take away meal. Examination was unremarkable but he was admitted for observation. That evening he collapsed. His blood pressure was 80/40 and responded to fluid resuscitation. Discharge was planned for the following day, but his haemoglobin concentration was found to be 6.6 g/dl. Results of upper gastrointestinal endoscopy and colonoscopy were normal. Computed tomography showed a large haematoma lateral to the gastric wall, and a mesenteric angiogram identified an inferior pancreaticoduodenal artery aneurysm that we assumed had ruptured and resealed. After transcatheter embolisation to treat the aneurysm no further blood loss occurred. We found no cause for the aneurysm.James A Gossage, senior house officer, Mathew Forshaw, specialist registrar in general surgery, St Thomas's Hospital, …