Introduction: Marginal ulceration is one of common complications in patient who received pylorus-preserving pancreaticoduodenectomy (PPPD). The variation of incidence rate was wide and it was related with different reconstruction method. In this presentation, we will share our experience on a case of perforated peptic ulceration 21months after robotic PPPD and review the literature. Method: An 80-year-old man presented with watery diarrhea followed by acute abdominal pain for two days. Physical examination revealed hypoactive bowel sounds, muscle guarding, diffused rebounding pain. Computed abdominal tomography scan with contrast showed pneumoperitoneum and small amount ascites, wall thickening at anastomosis of jejunum and proximal efferent loop. He was diagnosed with hollow organ perforation. His medical history was panbronchiolitis under Erythromycin 500mg QD, type 2 diabetes mellitus under insulin control for 8 years, HbA1c: 6.9% and periampullary vater tubular adenoma with foci of high grade dysplasia post robotic-assisted PPPD with reconstruction by Traverso’s method 21 months ago. Post-operative antacid medication was administered for 4 months. Result: The patient received emergent exploratory laparotomy. A 0.5 cm ulcerative perforation over anterior wall of jejunal side of gastro-jejunosotmy was noted during surgery. Simple closure of perforation and feeding jejunostomy were performed for this patient. After surgery, pantoprazole was administered. The patient was discharged on the 14th day after emergent surgery. The incidence of marginal ulceration after PPPD with reconstruction by Traverso’s method was 6.9% in several studies. From July 2017 to March, 2019, total 230 patients received robotic PPPD. There are 3 cases of marginal ulceration with perforation after robotic PD at our hospital, incidence rate was 1.3% (3/230). Conclusion: Since marginal ulcer could be one of the complications and even lead to perforation after robotic PD, routine antacid medication is recommended for each patient undergoing a major operation such as robotic PD although done by minimal invasive approach.