Figure 1: Computer Tomography of Chest Abdomen and Pelvis with Contrast, Coronal View, showing a small focus of active contrast extravasation in the rectum with intraluminal blood in the left colon and rectum.

At this time, surgery was planned for surgical intervention with hemorrhoidectomy and recommended for a repeat colonoscopy postoperatively as the patient had blood in ascending colon on prior colonoscopy. However, the patient had a hypotensive episode after having a large bloody bowel movement. At that time, the patient was undergoing a blood transfusion. His blood pressure was noted to be 89/56, and he had a heart rate of 107 bpm. At that time, the patient endorsed dizziness, and he was given a 1 L IV fluid bolus with improvement of his blood pressure to 113/72 mmHg. However patient became more disoriented. Critical care was consulted, and an additional unit of RBC, FFP, and platelets was recommended. Surgery was contacted, and a proctoscopy was performed bedside, which showed a large amount of clots however, will believed to be unlikely due to hemorrhoidal bleeding. The patient was transferred to the ICU for further monitoring. The following day, the patient had a colonoscopy performed to evaluate the etiology of lower GI bleeding further, which showed an ascending colon Dieulafoy lesion with active bleeding (Figure 2&3). The site was treated with an epinephrine injection and three hemostatic endoscopic clips.