Case Presentation: A 63-year-old gentleman with a history of unprovoked left lower leg deep vein thrombosis (DVT) on rivaroxaban and seizure disorder on phenytoin, presented with acute onset abdominal pain, hematochezia, vomiting for two days. On presentation patient was tachycardic with a heart rate of 130/min, a physical exam revealed a distended and tender abdomen. [...]