A 45 year old woman with a history of hypertension, s/p total hysterectomy was admitted for unstable angina. She had a positive stress test and underwent a left heart catheterization (LHC) during her hospitalization that was normal. Her catheterization site was sealed with a vascular sealing device and was without external hematoma. Her precatheterization Hgb was 13.3 mg/dL. One day post-LHC, she complained of dysuria. A urinalysis was normal and she was discharged for outpatient evaluation of her chest pain. The patient developed worsening dysuria, frequency, and urgency and was prescribed antibiotics over the telephone for the treatment of a presumed UTI. Her symptoms improved but did not resolve and she was seen in the office 2 weeks later now also complaining of new constipation. Examination revealed normal vitals, a shuffling gait and rebound tenderness on abdominal exam. Pelvic exam revealed a tender, non-pulsating mass in the right lower quadrant. The catheterization site was identified as above the inguinal ligament and did not show any external signs of hematoma. An ultrasound and CT of the pelvis and abdomen revealed a 12Â7Â8cm mass overlying the iliac artery consistent with a hematoma and blood tracking up the right paracolic gutter. The bladder and colon were compressed by the mass. Doppler studies did not reveal active arterial flow from the iliac arteries. Her hemoglobin was 9.6 mg/dL. The patient was admitted for supportive care and her symptoms improved. DISCUSSION: Cardiac catherization is a common procedure with serious potential complications including a 1% risk of vascular injury including intraperitoneal bleeding. Risk factors for complications include female gender, congestive heart failure, percutaneous transluminal coronary angioplasty, valvuloplasty and peripheral vascular disease. The recent increased use of vascular sealing devices may decrease the risk of hemorrhage from anterior arterial perforation, but will not provide hemostasis from a posterior wall puncture. Thoughtful surveillance for post-LHC complications is essential. Management of peritoneal hematomas should include serial hemoglobins, diagnostic imaging and surgical consultation when necessary. In this patient, her post-LHC bleeding was misdiagnosed as a urinary tract infection. The Internist must recognize that post-LHC complications may masquerade as more common pathology leading to delayed diagnosis and potentially poor outcomes. presented to an outpatient clinic seeking primary care. Her complaints were depression and high blood pressure. Her primary language was Korean, but she spoke moderately fluent English. On exam she was oriented to person and place, but was hard to interview as she shifted from topic to topic. Depressive symptoms were not present, nor were symptoms of psychosis. Over the course of a few months she came often but erratically to clinic with vague complaints. She often discontinued her medications without any clear reasons. The nurses noted that although they understood her English, they could never tell what she wanted. They wondered if she was schizophrenic. After struggling to understand her clearly a Korean interpreter was obtained. This interpreter said that in Korean she was difficult to understand as well. After psychiatric evaluation which confirmed lack of mental illness, neuropsychometric testing was done with an interpreter. This revealed mental retardation with developmental disability especially in areas of language. DISCUSSION: Mental retardation is often defined by a composite IQ of less than 70. Developmental disabilities are very prevelent and encompass overt mental retardation as well as less pervasive cognitive deficits. As in this case, these patients can have difficulty with reading and communicating clearly, which can be a barrier to effective healthcare. Most people in the US are screened for this in school or childhood clinic visits. Many adult immigrants likely were not screened. When this diagnosis is known accomodation can be made to improve compliance and effective communication. Also, a diagnosis of mental retardation may qualify a patient for government benefits and outpatient social services. This case highlights the need to diagnose developmental disabiltiy and differentiate it from mental illness especially in adult immigrants. To recognize the preliminary management for IPA.  CASE INFORMATION: A 28 year old female presented requesting prenatal vitamins and  offered no complaints. PMH was significant for exploratory laparoscopies for abdominal pain and endometriosis. The patient was in graduate school and had been married for 1.5 years. When asked``do you always feel safe at home?'', she was noted to hesitate, whereas on previous questions, she answered rapidly. This question was immediately followed by``does your husband ever hit you, yell at you, or make you feel afraid?'' She replied that while she knows her husband loves her, on occasions he does get``upset''. They have frequent arguments, during which he breaks furniture and hits her. She stated``he never hits me hard'', he``always apologizes immediately'', and his hitting has``never gotten out of hand''. She denied having a plan of action should that happen. There were no weapons in the house. Patient was immediately referred to a psychologist for counseling and who helped her to formulate a safety plan. DISCUSSION: Intimate partner abuse (IPA) is common, with an estimated prevalence of 5 ± 20% women per year. It is defined as a pattern of intentionally coercive and violent behavior toward an individual with whom there is or has been an intimate relationship. These behaviors can be used to establish control over an individual and include physical and sexual abuse, psychological abuse with verbal intimidation, progressive social isolation or deprivation, and economic control. IPV transcends social classes and so all women should be asked about safety in their current setting as part of routine primary care and when presenting for emergency care with traumatic injuries. A screening question can be``have you been hit, kicked, punched, or otherwise hurt by someone within the past year? If so by whom?'' The physician must then make an assessment of the patient's safety, ascertaining the presence of weapons in the house, violence that is increasing in severity or intensity, threats to kill the woman or her children, and the woman having told her partner she is``planning to leave.'' It is important to give the patient validation and support and help her to develop a safety plan. Physicians should be aware of resources within their institution, which include social workers or domestic violence advocates. If these are unavailable the physician can provide counseling and give referral to a local domestic violence hotline. A 32 year old woman presented with bright red blood per rectum associated with tenesmus and urgency. She then developed left lower quadrant pain. There was no fever, rash, eye or joint pain. There was no foreign travel, unusual food intake, or history of antibiotic, NSAID or oral contraceptive use. Her past medical history was unremarkable. She had no known drug allergies, used alcohol on occasion, and did not use illicit drugs. Examination revealed postural hypotension, scant bowel sounds, and tenderness in the left lower quadrant. Rectal exam showed gross blood. Investigations revealed hemoglobin 141, platelet count 270, and wbc of 14.7. Electrolytes, INR, PTT, liver profile, amylase, and beta-HCG was negative. Abdominal films were normal. Micrologic examination of the stool was negative. Colonoscopy showed erythematous, friable mucosa from 75 cm (mid descending colon) to 35 cm distal to the anus. Pathology revealed patchy disease with inflammatory exudates on the surface, consistent with ischemic colitis. No crypt abscesses or granulomas were identified. A vasculitic workup was performed, with negative ANA, pANCA, cANCA, and normal complement levels. Hepatitis B and C serology were negative. Antithrombin III, Protein C, Protein S, homocysteine, Factor V Leiden genotype, and anticardiolipin antibody were all normal. Her diarrhea improved within 3 days of admission with conservative treatment, and she was discharged on ASA. She has had no recurrence. DISCUSSION: Internists frequently consider ischemic colitis in the differential diagnosis of the elderly patient who presents with bloody diarrhea. However, ischemic colitis in young patients is more common than realized. Case series in younger patients have described an increased risk in women, and a lack of vascular risk factors, when compared to the typical older patient with ischemic colitis, who has multiple vascular risk factors. Etiologic agents that have been implicated include estrogen, collagen vascular disease, diabetes, hypercoagulable states, cocaine use and even long distance running. It is also common to find no identifiable etiologic cause. In an analysis of 68 consecutive cases diagnosed by early colonoscopy, 23 (34%) of the patients were younger than 50 and nineteen of those were women. Habu found that the associated factors for ischemic colitis were an increased incidence of chronic constipation and a prior history of abdominal surgery. Our case illustrates the importance of consideration of ischemic colitis in the differential diagnosis of bloody diarrhea in the younger patient.