A 64 year-old man that that presented a history of weight loss of 26 pounds with several upper gastrointestinal hemorrhages. The patient had two previous upper endoscopies elsewhere that apparently report as chronic ulcer of duodenal bulb and another one in a national public hospital. This image was thought to be a Gastric Carcinoma, the biopsies taken by endoscopy did not show malign tissue. The patient had surgery due to obstructive symptoms and in suspicion of malignancy but the surgical finding and pathological finding did not reveal cancer. At surgery, the ulcer was found to be penetrating into Transverse colon with fistula. A Billroth II gastrectomy was performed with partial resection of transverse colon. At that time we did not know that the patient had ZE syndrome.
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