A case report and review of the literature of benign gastric ulcer complicated by gastrocolic fistula are presented. Twenty-seven percent of patients were found to be receiving ulcerogenic medications. Only 15% of patients had previous histories of ulcer disease. Parameters most suggestive of a neoplastic process included palpable abdominal mass and unexplained anemia. Diagnosis is established by barium enema. Endoscopic biopsy and cytologic studies are useful in differentiating benign from malignant processes. Surgical management of benign ulcers complicated by fistula results in more than 90% survival.