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An 83-year-old male presented to the emergency department with a history of heavy rectal blood loss. He described copious amounts of fresh blood with multiple clots. There was no previous history of colonic bleeding or prior colonic investigation. Past medical history included atrial fibrillation for which he was on warfarin.
On examination he was haemodynamically unstable with a pulse rate of 100 bpm and blood pressure of 104/50 mm Hg. Haemoglobin was 8.6 g/dl and international normalised ratio (INR) was 3. He was immediately resuscitated with packed red cells and fresh frozen plasma.
Colonoscopy was not possible as the rate of bleeding and the fact …