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Dieulafoy’s lesion (DL) is an uncommon vascular malformation characterised by an abnormally large submucosal artery that can cause gastrointestinal bleeding.1 Although DL most commonly occurs in the upper gastrointestinal tract,1 lesions have been described throughout the gastrointestinal tract2; however, rectal DL remains exceptionally rare.3 4 Recognition may be difficult because bleeding can be intermittent, the lesion may be overlooked when quiescent, and—particularly in the rectum—it may mimic other pathology, including neoplasia.5 We report an unusually low rectal DL presenting as a pigmented polypoid lesion.