Abstract
A 58-year-old man with a history of mechanical aortic valve replacement, on anticoagulation with warfarin, presented to the emergency department with hematochezia 1 day after undergoing transrectal ultrasound-guided prostate biopsy. On presentation, he was found to have hemorrhagic shock. Fluid resuscitation, packed red blood cell transfusion, and empiric antibiotic therapy were initiated, and the patient was admitted to an intensive care unit. Abdominal-pelvic computed tomography demonstrated portomesenteric venous gas and pneumatosis intestinalis. Colonoscopy showed ischemic ulcers at the ascending colon and stigmata of recent bleeding at the site of biopsy in the rectum, which was treated endoscopically. The patient was discharged after continued improvement during hospitalization. On follow-up, the patient continued to be symptom-free, and a repeat colonoscopy demonstrated healing colonic ulcers.