Bullous lesions in nitrazepam overdosage.

sided abdominal pain followed by bloody diarrhoea which rapidly improved without specific treatment. The bariumenema examination showed changes at the typical site which progressed from narrowing with marginal thumb-printing, through sacculation, to complete normality (Boley et al., 1963; Marston et al., 1966; Lea Thomas, 1968; Williams et al., 1969). The only unusual feature was the patient's age and sex. The condition usually occurs in the age group at risk from degenerative vascular disease, more common in men (Morson, 1968). In a series of 36 patients with a mean age of 62 (range 42-82) reported by Lea Thomas (1968) the younger patients were mainly women with cardiac or rheumatoid disease. Though the morbidity is that of acute ischaemia (Marston et al., 1966, 1969; Morson, 1968) and large and small arterial changes may sometimes be found, aortography usually shows nothing abnormal, possibly because the smaller arteries and veins cannot be seen by this technique (Lea Thomas, 1968). In view of this patient's age and sex and the absence of other precipitating factors it is reasonable to discuss her use of the contraceptive pill. An increased risk of pulmonary embolism, deep-vein thrombosis, and cerebral and coronary thrombosis has been established in women taking oral contraceptives in the United Kingdom (Inman et al., 1970), especially those containing larger amounts of oestrogens. Gangrene of the small bowel, superior mesenteric artery thrombosis (Brennan et al., 1968), and also mesenteric venous thrombosis (Reed and Coon, 1963); Civetta and Kolodny, 1970) have been described. Kilpatrick et al. (1968) discussed the cases of two patients aged 29 and 32 taking oral contraceptives who showed radiological evidence of transient ischaemic colitis. These patients together with the present case suggest an aetiological relationship. We feel that ischaemic colitis should be considered in all young women who present with acute abdominal pain and blood-stained diarrhoea who are taking a contraceptive pill.