Giant gastric ulcers are defined as ulcers measuring 2cm or more. They are known to perforate. Gastrectomy is the procedure of choice in a stable patient. We are presenting an atypical variety of giant gastric ulcer perforation with an associated small pyloric perforation. Introduction Gastric ulcers have been classified into five different types according to the modified Johnson’s classification1. Giant gastric ulcer is defined as an ulcer measuring 2cm or more2. It usually presents on the lesser curve aspect of the stomach; nevertheless, any type of gastric ulcer may present as a giant ulcer. It has a high likelihood of developing complications3. We came across a very large gastric perforation with an associated small pyloric perforation in a 55-year-old male, the kind of which seems not to have been reported before.The patient presented as a case of perforation peritonitis. The diagnosis was confirmed on chest X-ray which showed gas under the right dome of the diaphragm. After the necessary preliminary treatment, the patient was taken for surgery which initially revealed a small perforation in the pyloroduodenal region. The left lobe of the liver was adhered to the anterior surface of the body of the stomach. Adhesiolysis was performed and an extremely large gastric perforation along the lesser curve of the stomach, measuring approximately 11-12cm and extending from below the fundus up to the pyloric antrum came into view (fig. 1, fig. 2). Initially we appreciated the smaller perforation to be present in the first part of the duodenum; however, on close observation it turned out to be a pyloric perforation (fig. 1). The giant perforation was so big that nearly the whole anterior wall of the body of the stomach was conspicuous by its absence and the posterior mucosal folds were clearly visible (fig. 1, fig. 2).
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