Rectal bleeding is often seen in patients who undergo transrectal ultrasound-guided prostate biopsy. It is usually mild and stops spontaneously. We report what we believe is the first case of life threatening rectal bleeding following this procedure which was successfully treated with angiographic embolization. An endoscopic injection of epinephrine done on admission achieved only temporary hemostasis and the patient developed a second episode of massive rectal bleeding that warranted angiographic treatment. We present this case in detail and review other alternatives for treating fulminant rectal bleed which is a consequence of this procedure.

Hypertriglyceridemia induced pancreatitis in pregnancy is established and has been widely reported. However there are very scanty reports of cases involving the use of total parenteral nutrition. We report the case of a 37-year-old gravida 3, para 2 woman at 34 weeks of gestation who presented with one day of severe epigastric pain radiating to the back, nausea and bilious vomiting caused by pancreatitis induced by hypertriglyceridemia. Her initial serum triglyceride, amylase and lipase concentration were 6,552 mg/dl, 314 U/L and 537 U/L respectively. She initially received intravenous fluids and insulin with reduction of serum triglyceride levels to 583 mg/dl on the fifth day of admission. However attempts to refeed the patient with solid food resulted in induction of hypertriglyceridemia and relapse of pancreatitis. Lipid free total parenteral nutrition was commenced in the third week of admission and lead to a better control of triglyciderides and resolution of pancreatitis until delivery of a full term healthy neonate.

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