45 year old man with burning epigastric pain for several years. The pain tended to occur 1 to 3 hours after meals and was worse at night. He presented at the Emergency Department with severe malaena (upper gastrointestinal tract bleeding manifesting as dark tarry stools), and was found to be hypotensive.
The lesser curve shows a solitary ovoid, punched-out crater, 1.8 x 1.3 cm, with the surrounding congested mucosal folds radiating from it. The ulcer has penetrated into the muscularis propria exposing an eroded thickened artery. No perforation is seen.