Angiodysplasia as a rare cause of acute hematochezia in a 33-year-old with vascular risk factors: a case report.

Background: Rectal angiodysplasia is a vascular malformation typically associated with the elderly. It is an exceedingly rare cause of acute lower gastrointestinal bleeding (LGIB) in young adults. We present a unique case of massive hematochezia in a 33-year-old, potentially accelerated by long-standing vascular stress. Case presentation: A 33-year-old male with a history of chronic alcohol use and poorly controlled hypertension presented with acute, massive hematochezia and symptomatic anemia. Physical examination and initial labs may indicate significant blood loss. Urgent colonoscopy revealed multiple punctate, actively bleeding angiodysplastic lesions localized strictly to the rectum. Given the focal nature of the lesions, hemostasis was achieved using mechanical endoscopic titanium clips. No recurrent bleeding occurred during 6 months of follow-up. Conclusion: This single-case observation suggests that angiodysplasia may be considered in differential diagnosis for LGIB even in younger patients, particularly those with systemic vascular risk factors like hypertension and chronic alcohol consumption. Furthermore, it may indicate that mechanical clipping is a highly effective, targeted alternative to thermal ablation for localized rectal vascular lesions.