Peptic ulcer disease remains one of the most common outpatient diagnosis in GI clinical practice. A large majority of cases are contributed to H.pylori infection and/or NSAID use. Other less common causes are Zollinger Ellison syndrome, antral G-cell hyperfunction, trauma, burns, smoking and psychologic stress. The three most common complications are bleeding, perforation and obstruction. Perforated peptic ulcers presents as acute abdomen to the emergency department usually. Ulcer recurrence is often related to H.pylori and/or NSAIDs. It can also be due to gastrin secreting tumors or even smoking. Recurrence of peptic ulcer perforation has limited documentation and has no standardized method of management. With an unknown incidence, it's a surgeon's dilemma and has to be managed specic to each presentation. Here, I would like to discuss a case of a 70 year old man, who presented with recurrent episodes of duodenal perforation in an interval of 2 years.