A 72-year-old man was brought to the ED after passing melena for 1 day and multiple falls. The patient had recently undergone a lobectomy for non-small cell lung cancer and was recovering in a rehabilitation facility. He had a history of ischemic stroke and was taking an oral direct thrombin inhibitor. At presentation, he was conversant and hemodynamically stable, his hemoglobin level was 4.4 g/dL, international normalized ratio was 4.4, and lactate level was 2.1 mmol/L. IV access was obtained, and a Foley catheter was inserted. A nasogastric tube was placed and revealed scant coffee-ground drainage. Treatment was started with continuous infusion of IV proton pump inhibitors, and the patient received one unit of packed RBCs and two units of fresh frozen plasma. Shortly thereafter, the patient became diaphoretic, unresponsive, and tachypneic, and he demonstrated diffuse abdominal tenderness. He was intubated for airway protection. Examination revealed pallor, anuria, clear breath sounds, and a rigid abdomen. Repeated testing revealed his lactate level was elevated to 8 mmol/L, and hemoglobin level was 3.5 g/dL. A focused assessment with sonography for trauma (FAST) examination was performed to evaluate the abdominal findings and to search for a focus of bleeding. The ultrasound findings are shown in Videos 1-3.