When hematochezia becomes a red herring

An 81-year-old male patient presented on the emergency ward for hematochezia, without any other complaints. Rectosigmoidoscopy showed a predominant patchy inflammation of the mucosa with several bluish blebs (submucosal hemorrhage) and small ulcerations. (Figure 1A). Subsequent elective colonoscopy (1) revealed multiple submucosal hematomas and mucosal lacerations throughout the entire colon in between normal mucosa. During the procedure spontaneous mucosal tears occurred. (Figure 1B). Multiple biopsies were taken.