The etiology of duodenal diverticula still remains a disputed question. Keith felt that the lesions were acquired because of traction from without, as adhesions following gallbladder disease or pancreatitis. The case here reported is of interest because it presents the combination of a duodenal diverticulum, caused apparently by the traction of adhesions about the common bile duct and the duodenum, and secondly, because of rather prominent longitudinal markings in the lower third of the esophagus, which proved to be varicosities. History.—The patient was a male, Italian farmer, aged 53. He entered the hospital with a complaint of intermittent dull pain in the epigastrium and left upper quadrant, which dated back about one and one-half years. The pain was accentuated by food and not relieved by ordinary medical remedies. The attacks would start in the mid-epigastrium, radiate to both upper quadrants, and were sufficiently severe to double the patient up. They were accompanied with nausea but no vomiting except on two occasions, one just before, and a second two weeks after, entry into the hospital, when the patient vomited about one pint of bright red blood. His stools had been tarry on several occasions. Within the month previous to entry the patient had lost about 15 pounds in weight. His past history and family history were negative except for the habit of drinking wine with all meals. Physical Examination.—The mucous membranes were pale. The lung findings suggested emphysema. The heart sounds suggested a mitral insufficiency and the vessels were markedly sclerotic. Throughout the upper abdomen there was definite guarding and tenderness. On deep palpation an indefinite mass was felt across the upper abdomen. The laboratory findings revealed a moderate secondary anemia and a leukopenia. The stools gave a markedly positive guaiac test while on a meat-free diet. The Rose Bengal liver function test showed evidence of liver damage. At this time it was felt that the patient's disease was carcinoma of the stomach, with metastases to the liver, consequently a roentgen examination of the gastro-intestinal tract was made. There was a definite but slight dilatation of, and delay in, the lower part of the esophagus. Markings, simulating those of rugal lines, were more definite than usual in the lower end of the esophagus. The cardiac end of the stomach showed some hypertrophic rugae. Peristalsis passed completely over the usual portions of the stomach. The duodenal bulb was quite large and was definitely indented in the apical region. The posterior part of the first portion of the duodenum appeared to be somewhat lower than normal, relative to the cap. There was a large bilobed diverticulum extending to the left of, and slightly anterior to, the lower third of the descending portion of the duodenum. At six hours the stomach and diverticulum were empty. The remainder of the tract was not remarkable. Pathological Report.