Lymphangiomas are rare benign cysts caused by congenital malformation of the lymphatic system. The incidence of lymphangiomas is between 1.2:1,000 to 4:10,000 births per year. Amongst lymphangiomas 80-90% originate from the head and neck. Intra-abdominal lymphangiomas make up about 5% of lymphangiomas. There is no specific data on the incidence of colonic lesions. We present a case of a 38 year old female with no significant past medical history presenting with bright red blood per rectum. The patient had been having issues with chronic hematochezia since her teenage years, which had been attributed to hemorrhoids. The patient denied any early satiety, nausea, vomiting, unintentional weight loss, or black stools. Physical exam was unremarkable, except for a palpable mass on rectal exam. Laboratory evaluation revealed a microcytic anemia, but otherwise was within normal limits. She had never before undergone endoscopic evaluation. The patient subsequently underwent a full colonoscopy that revealed an extensive network of cyst like structures from just proximal to her dentate line to 15 cm. These lesions were examined radiographically, endoscopically, and via endoscopic ultrasound (EUS). EUS and MRI investigations demonstrated extent of disease down into the perirectal fat region, but with no invasion of adjacent structures. Biopsies of the lesion revealed multiple areas of dilated lymph vessels extending into the muscularis mucosae lined with endothelial cells, diagnostic of lymphangioma. The approach to treatment of lymphangiomas is varied, from conservative expectant course to sclerosant injections and aspiration, to surgical resection. There are reported cases of spontaneous regression, up to 15-20%. Recurrence rates of 50% are reported with surgery. Although very rare, there is a potential risk for malignant transformation. The patient ultimately elected for the expectant course. This case demonstrates a rare cause for hematochezia, which emphasizes the importance of a broad differential diagnosis, and the need to not discount patient's symptoms regardless of prior evaluations.Figure 1Figure 2