INTRODUCTION: Small bowel ulceration can be difficult to diagnose and maybe confused with perforation or intestinal obstruction. The differential considerations for small bowel ulceration include inflammatory causes: PUD, isolated terminal ileal ulcers, drug induced, Crohn's disease. Vascular disorders: vasculitis, Behcet's, vascular dysplasia, microangiopathic ischemic ulcers, veno-occulsive. Other causes: ischemia, neoplasia and more. We are reporting a case of diffuse jejunal ulceration after episode of hypotension diagnosed by capsule endoscopy (CE). CASE DESCRIPTION/METHODS: 75 yo male veteran with IBS-C, CAD, CHF, A fib on ApixabanPatient admitted for acute CHF exacerbation. Hgb was decreased to 8.1 g/dl (baseline 13 g/dl). Patient denied hematemesis, hematochezia, melena Due to patient cardiac issues, we used CE to evaluate for possible GI bleed. CE findings noted for AVM in early jejunum, distal jejunal polyp, bleeding ileal AVM. He was transferred to another facility for single balloon enteroscopy (SBE) with ablation of 4 areas of AVM's. A tattoo was placed to the most distal area of the jejunum reached. The jejunal polyp wasn't seen on SBE. Post procedure he developed hypotension, and started on pressor for blood pressure (BP) support. The patient was transferred back to our facility after 2 weeks. We were asked to evaluate if the jejunal polyp was missed on SBE. A repeat CE showed: multiple areas of severe, large circumferential ulceration throughout the jejunum. Jejunal polyp was noted distal to the tattoo, bleeding AVM in the ileum again. Anticoagulation was held and started iron supplement. DISCUSSION: Patients needing pressor support for BP control are at risk for CV events such as intestinal ischemia. Given the acute changes in the small bowel seen on the CE, likely due to either the hypotensive episode or use of vasoactive drugs to support the patient's BP. In our literature search, we didn't find any reports on acute extensive jejunal ulceration following a hypotensive episode or after use of vasoactive drugs. This entity may be under reported due to patients' hemodynamic instability preventing endoscopic eval. In general, unless targeted the small bowel is not routinely evaluated. We propose using CE, which requires minimal prep and no anesthesia, to help reveal the diagnosis of ileal ischemia in patients with pressor support or hypotension that aren't responding to supportive measures in order to alter the clinical intervention. This can be done as a future prospective study in ICU patients.