Introduction:Lower gastrointestinal bleeding (LGIB) is a significant clinical concern, accounting for about 30% of major gastrointestinal bleeding episodes requiring hospitalization. While upper gastrointestinal sources are more common, lower GI bleeding presents a diverse array of potential etiologies, ranging from diverticulosis and angioectasias to ischemic colitis, neoplasms, and hemorrhoids [1].Dieulafoy lesions represent a unique vascular anomaly within the GI tract, characterized by an abnormally large submucosal artery that erodes the overlying mucosa without an associated ulcer or erosion, potentially leading to significant bleeding [2]. Dieulafoy lesions stand out as a rare but noteworthy cause of LGIB, constituting about 2% of acute GI bleeds [3]. These lesions are more commonly associated with the upper GI tract, typically in the stomach near the gastroesophageal junction, due to the vascular supply from the left gastric artery branches. However, they can occur throughout the GI tract, including the colon, though this presentation is rare [2,4].The pathogenesis of Dieulafoy lesions is not completely understood, but arterial wall necrosis leading to rupture has been suggested. Additionally, risk factors such as NSAIDs, tobacco, alcohol use, and peptic ulcer disease may exacerbate the potential for bleeding from these lesions [2]. The diagnosis is typically made endoscopically, with criteria including the presence of a protruding vessel or active bleeding from a small mucosal defect surrounded by normal tissue [2].Endoscopic intervention remains the cornerstone of treatment, with mechanical modalities like band ligation and hemostatic clips being highly effective. Combination therapy has been shown to be superior to monotherapy in achieving hemostasis, which is successful in approximately 80-85% of cases [2].The case we present emphasizes the importance of considering Dieulafoy lesions in the differential diagnosis of LGIB, given their potential for significant blood loss and the effectiveness of prompt endoscopic intervention in resolving bleeding and stabilizing patients.

A Symphony of Anomalies: Isolated Pulmonary Artery Agenesis Meets Congenital Lung HypoplasiaNida Ansari, D.O.1, Sacide S. Ozgur, M.D.1, Alan Alcantara, M.D.1, Yasmeen Sultana, M.D.1Disclosure of Interest: The authors report no conflict of interest. An ethical review is not necessary because this is a case report. This research received no specific grant from funding agencies in the public, commercial, or not-for-profit sectors.Consent: As this is a case report, consent was obtained for the purpose of this paper.Acknowledgments: We would like to acknowledge the patient and his family for allowing us to share this case with our colleagues.Author affiliation: Ansari, N, Ozgur, S, Alcantara, A, performed the literature review and wrote the manuscript, and all authors contributed to the writing, the final editing, and the collection of the patient’s clinical data. All work was performed at St. Joseph’s University Medical Center at the following address:St. Joseph’s University Medical Center Department of Internal Medicine 703 Main Street Paterson, NJ USA 07503 973-754-2000All authors, including the corresponding author, may be reached using the aforementioned contact information.