INTRODUCTION: Alcoholic cirrhosis is one of the most common causes of liver failure, accounting for millions of hospitalizations each year. Although esophageal, gastric, and rectal varices are extensively described as a result of portal hypertension, small bowel varices (SBV) are rarely implicated as a source of GI bleeding. This report describes a unique case of isolated SBV resulting in overt GI hemorrhage. CASE DESCRIPTION/METHODS: A 54-year-old female with a history of alcoholic cirrhosis decompensated by esophageal varices, hepatic encephalopathy, and abdominal ascites (MELD-Na 19) presented to the ED after multiple episodes of melena and hematochezia. The patient had previously undergone transjugular portosystemic shunting (TIPS) for recurrent variceal bleeding. The patient underwent an EGD which showed mild portal hypertensive gastropathy but no gastric or esophageal varices. Her colonoscopy was unremarkable. Given ongoing bleeding, the patient underwent a capsule endoscopy which revealed fresh blood with clots two-thirds (65%) of the way through the jejunum. A CT angiography revealed a portosystemic shunt between the superior mesenteric vein and the common femoral vein near the jejunum. Interventional radiology performed a catheter guided coil and glue embolization of the venous malformation and created a new portosystemic shunt. The patient’s melena and hematochezia ceased, and she was safely discharged home. DISCUSSION: Caused by portal hypertension, SBV are rare and infrequently implicated in significant GI hemorrhage. This case is unique in that the patient had no gastric, esophageal, or rectal varices. Isolated SBV are described anecdotally in the literature and extremely unlikely to manifest clinically. In addition, this case highlights the potential utility for inpatient video capsule endoscopy (VCE). In a patient with persistent GI bleeding with normal endoscopy and colonoscopy should certainly be considered for a deeper luminal exam. Furthermore, the definitive management of SBV is not well defined. While the mainstay of treatment is supportive care, minimally invasive vascular interventions provide an exciting option for management.