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We present a case of a 54-year-old male who was transferred to our hospital with massive hematochezia. He reported previous colonic hyperplasic polyps and sporadic intake of anti-inflammatory for headache. He denied any history of abdominal pain, change in bowel habit, weight loss, previous history of bleeding or other symptoms. Aside from pallor of skin and mucosae no other physical abnormalities were noted. The patient was hemodynamically unstable (blood pressure-92/48 mmHg; heart rate-102 beats per minute), with a haemoglobin8,2 g/dl and hematocrit-25,4%, and needed 2 units of blood to be stabilized. All other laboratory tests were normal as well as upper endoscopy. Colonoscopy revealed blood clots throughout the entire colon. The following day, colonoscopy with ileoscopy (the last 10 cm) was repeated and no bleeding lesion was identified. Abdominal-pelvic computed tomography did not reveal any abnormality. On the third day of admission, CE was performed and revealed a small rounded lesion in the ileum with a depressed center, which looked like a submucosal tumor with spurting bleeding (Fig. 1). The patient remained hemodynamically stable. On the seventh day of admission, the patient had a planned exploratory laparotomy. A 1.5 cm nodular lesion was found in the ileum, about 70 cm from the ileocecal valve (Fig. 2). No metastases were detected intraoperatively. Segmental ileal and mesentery resection was performed. Histopathologic evaluation, including immohistochemistry study, revealed a carcinoid tumor (1.5 x 1.4 x 0.4 cm) with mucosal ulceration, invading the muscularis propria, but without vascular or regional lymph node invasion (Fig. 2). Measurements of serum chromogranin A and urinary 5hidroxyindole acetic were within normal ranges. The patient was discharged after an uneventful postoperative recovery. After a 12 month follow-up, there was no recurrence of haemorrhage and surveillance exams were normal.

Obscure gastrointestinal bleeding due to ileal carcinoid tumor diagnosed by capsule endoscopy