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A 63-year-old man was admitted to our hospital with rectal bleeding. He had a history of Billroth II surgery for bleeding peptic ulcer disease 30 years ago. He had no other medical problems, and was receiving no medications. His hemoglobin level was 5.6 g/dL. Upper gastrointestinal endoscopy revealed fresh blood and clots in the residual stomach and efferent loop. A Dieulafoy lesion with spurting hemorrhage was found near the gastrojejunal anastomosis ([Fig. 1 a]).