The patient underwent endoscopy, and a large ulcer in the duodenal bulb was found, she received conservative medical treatment in ICU, several days after the CT scan patient emergently went to the operating room because of massive upper GI bleeding. A large defect of the duodenal bulb found on surgery, connected with the mentioned cavity. The cavity was confined to the pancreas posteromedially and contains fresh blood. Active bleeding from the gastroduodenal artery found on exploration. A perforated peptic ulcer confined by the pancreas or other organs is a penetrated ulcer.