A 16-year-old boy presented with dyspepsia, vomiting, weight loss and fever for 2 years following surgery for gastric outlet obstruction. On examination, he was pale and thin. Recurrent giant duodenal ulcer was diagnosed. Giant duodenal ulcers are defined as ulcers greater than 2cm occupying most of the duodenal bulb, affecting 1-2% of all duodenal ulcers. Causes include H. pylori, NSAIDs, primary duodenal cancer, Zollinger-Ellison syndrome, and Crohn's disease. Management involves intensive PPI therapy, stopping NSAIDs and smoking, close monitoring and biopsy to rule out malignancy. Refractory ulcers

1. Giant DUS:

4. Recurrent giant stomal ulcer in RIY DJ:

5. Recurrent giant stomal ulcer in RIY DJ: