WITH KLIPPEL-TRENAUNAY-WEBER SYNDROME. M. Kennedy 1 , C.V. Mueller 1 ; 1 University of Cincinnati, Cincinnati, OH (Tracking ID #77195) LEARNING OBJECTIVES: 1) Learn about the vascular malformations seen in Klippel-Trenaunay-Weber Syndrome. CASE INFORMATION: A 25 yo Caucasian male originally presented to an outside hospital with bright red blood per rectum. He denied associated abdominal pain, nausea, vomiting, fever or prior history of rectal bleeding. Initial systolic blood pressures were in the 80-90's with a heart rate in the 130's. Work up at the outside hospital included flexible sigmoidoscopy that revealed nonbleeding internal hemorrhoids, a negative tagged RBC scan and an unremarkable CT of the abdomen. Upon transfer to our facility, he was hemodynamically stable, but found to have a hemoglobin of 7.5 with a baseline of 13.5. The morning after admission, the patient developed massive hematochezia associated with diaphoresis and tachycardia. He was urgently sent for tagged RBC scan that showed distal ileal bleeding. Subsequent mesenteric angiography did not identify any active bleeding or vascular malformation. The patient again decompensated and was taken for exploratory laparotomy that revealed bleeding ileal and colonic varices. He underwent ileocecectomy without complications and had no further episodes of bleeding. He required a total of 20 units of PRBC's during his hospitalization. IMPLICATIONS/DISCUSSION: KTWS is classically described as a venous monoangiodysplasia, but is actually associated with a variety of vascular malformations including: subcutaneous hemangiomas, cavernous hemangiomas, AV fistulas, deep vein malformations and/or aplasias, varices and a variety of lymphatic abnormalities. Vascular malformations may involve visceral organs such as the bowel, liver, kidneys, and lungs and can, uncommonly, cause complications in those organs. Treatment of KTWS is supportive and/or cosmetic unless orthopedic or bleeding complications arise, at which point surgery is generally indicated.