Snap Shot A 74-year-old male is found on the bathroom floor with underwear saturated in bright red blood. The following angiogram was obtained. Introduction Massive acute bleeds caused by diverticular disease IBD AVMs neoplasms angiodysplasia anorectal disease ischemic colitis solitary ulcer Chronic rectal bleeds caused by hemorrhoids fissures CA polyps Presentation Symptoms bright red blood per rectum hematochezia (more common than melena) melena Evaluation NG tube or endoscopy rule out upper GI bleed Anoscope / sigmoidoscopy / colonoscopy if bleeding minimal and patient is stable Angiography Tagged-RBC study Treatment Stabilize patient, give fluids, type and cross IV fluids and transfusions for hemodynamic stability Surgery rarely required