INTRODUCTION: Dieulafoy’s lesion is a rare cause of upper GI bleeding and even a much rarer cause of cecal bleeding. It is most commonly located in the lesser curvature or proximal body of the stomach but rare occurrences in extra gastric sites have been reported. They often elude diagnosis due to their small size, normal surrounding mucosa and intermittent nature of bleeding episodes. CASE DESCRIPTION/METHODS: A 79 year old male with past medical history of CAD, Paroxysmal atrial fibrillation on long term anticoagulation with xarelto presented to the ED with complaints of dark tarry stools for 4 days. Hemoglobin level was noted to be 13.2g/dl two days prior to admission and on day of admission was noted to be 10.9gdl. Further work up revealed positive occult blood, TIBC level of 464, ferritin level of 57 and a transferrin saturation of 15. Xarelto was held and patient underwent upper and lower endoscopic assessment. Colonoscopic assessment revealed an active bleeding cecal dieulafoy’s lesion that was successfully clipped with three hemostatic clips and epinephrine infiltration to the surrounding area. Hemostasis was achieved, patient’s hemoglobin remained stable post procedure and he was subsequently discharged home after 48 hours. DISCUSSION: Dieulafoy’s lesion (DL) also known as caliber persistent artery accounts for about 1- 2 % of GI bleeding. It is a dilated aberrant submucosal artery that impinges and erodes through the muscularis mucosae. The overlying mucosa shows erosion and the surrounding mucosa appears normal. Almost two thirds of the lesions are located in the stomach along the lesser curvature. The remaining one third of lesions are extra gastric mostly involving the duodenum followed by the colon. Endoscopy is the gold standard of diagnosis but is only successful in detecting 49-70% of the lesions mostly because of the small nature of the lesions, normal surrounding mucosa and intermittent nature of hemorrhage. Repeat endoscopy is usually effective in diagnosis especially if repeated on a different occasion. Angiography is useful in diagnosis when endoscopic evaluation is unsuccessful in localizing the lesion. Treatment of DL involves a combination of epinephrine injection followed by bipolar probe coagulation, thermal coagulation or hemoclip placement. Conclusion: Dieulafoy’s lesion of the cecum, though rare, can be a cause of life-threatening lower GI bleeding and can easily be diagnosed and treated during endoscopic assessment.Figure 1.: An actively bleeding dieulafoy cecal lesion.Figure 2Figure 3.: Hemostasis achieved with three hemostatic clips.