'Kissing' peptic ulcers are rare clinical entity. Patients with kissing ulcers are at risk of perforation and bleeding. We are presenting a case of a perforated kissing gastric ulcer presenting as free air within an incarcerated ventral hernia, managed laparoscopically. Presentation: An 81-year-old obese female presented to ED with altered mental status. She had diffusely abdomen pain and tenderness with a large partially reducible epigastric hernia. Her Hematocrit was 15, with positive FOBT, Lactic acid of 2 and WBC of 8.4. She was transfused 2 units PRBC. NGT revealed coffee-ground material but subsequent lavage was negative. Stroke work up was negative. A CT scan of the abdomen showed pneumoperitoneum with oral contrast extravasation from distal stomach. Operative procedure: Diagnostic laparoscopy revealed an incarcerated epigastric hernia with herniated stomach. Upon reduction of the hernia a giant gastric ulcer was found on the anterior wall of the antrum with posterior kissing gastric ulcer with blood clot. Intraoperative EGD revealed no additional ulcers or mass. Hemostasis was achieved. The perforated gastric ulcer was closed vertically with a running absorbable suture and reinforced with omental flap. The abdomen was copiously irrigated. The epigastric hernia defect was closed primarily. Postoperative Patient did well. Post operative CT scan showed no leak or obstruction. Tolerated diet on POD # 5. Conclusion: When Kissing gastric ulcers presented with bleeding and accompanied by perforation, early surgery is mandatory. In hemodynamically stable patient a combined laparoscopic and endoscopic approach is a feasible modality for management of complicated kissing gastric ulcers.