Rectal Dieulafoy Lesion with Severe Hematochezia in a Warfarin-Treated Patient

Dieulafoy lesions (DLs) are rare vascular malformations in the gastrointestinal tract that often present with gastrointestinal bleeding, most commonly in the stomach. Rectal DLs are exceptionally rare, representing less than 2% of cases. Warfarin use increases the risk for bleeding and management represents a challenge. We present a case of a 60-year-old male on chronic warfarin therapy who presented with severe hematochezia due to a rectal DL, requiring more than one colonoscopy and prothrombin complex concentrate (PCC) administration. While guidelines recommend PCC over fresh frozen plasma (FFP), they acknowledge that this is based on very low certainty of evidence.