An Unsuspected Cause of Rectal Bleeding

Question: A 55-year-old previously healthy man presented to the emergency department with a 1-month history of spontaneous hematomas and hematochezia. Two weeks prior, he had banding of newly developed internal hemorrhoids. Physical examination revealed a large lumbosacral hematoma, hepatomegaly, and red blood per rectum. Laboratory studies were notable for a hemoglobin of 8.3 g/dL, platelet count of 97,000/mm3, international normalized ratio of...