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Introduction: Acute upper gastrointestinal bleeding is a common emergency presentation. The United States Centers for Disease Control and Prevention 2018 survey of emergency department (ED) visits reported 436,000 ED visits for unspecified gastrointestinal bleeding that year. 1 Case Report: We present the case of a submucosal duodenal pseudoaneurysm causing massive gastro-intestinal hemorrhage in a male on anticoagulation. Conclusion: Prompt recognition of critical gastrointestinal bleeding, appropriate ED management, and early consultation for emergent intervention are the essential components to reduce morbidity and mortality for patients with massive gastrointestinal hemorrhages.