Introduction: Gastrocolic Fistula (GCF) is a rare abdominal fistula typically associated with colonic and gastric malignancies. Historically peptic ulcer disease (PUD) was the most common aetiology; however such presentations are now rare owing to widespread proton pump inhibitor (PPI) use. Patients classically describe diarrhoea, weight loss and vomiting which may be faeculent, although the triad is only complete in 30% of patients. Treatment is typically surgical and depends on underlying cause. Case: A 68-year-old woman who presented with symptomatic anaemia secondary to gastrointestinal bleeding was found to have a large GCF on CT. She had a background of aspirin abuse, advanced chronic obstructive pulmonary disease and severe malnutrition. Endoscopy revealed intragastric faeculent content and fungating greater curvature and cardia ulcers. After a large pneumoperitoneum was incidentally found on a CT arranged to further define the fistula’s anatomy, decision was made to manage nonoperatively given poor surgical candidacy and likely peritoneal dissemination in the event of malignancy. She received PPI therapy, antibiotics, parenteral and naso-jejunal feeds. Biopsies were benign, and demonstrated H. pylori which was treated with triple therapy. Progress endoscopy at 6 months showed resolution of the fistula and near complete healing of her ulcers. Discussion: GCF secondary to PUD is an uncommon entity in modern surgical practice. Management consists of endoscopic biopsy, PPIs, H. pylori eradication if needed and nutritional optimisation. In fit patients fistulectomy is typically recommended although non-operative therapies alone may lead to complete resolution of the fistula as seen in this case.