Posterior perforation of gastric ulcer: a rare surgical emergency

BACKGROUND:Gastric ulcer perforation is a rare surgical emergency.Posterior gastric ulcer is even rarer and usually has a delayed presentation with attendant greater morbidity and mortality. AIM:To report a case of posterior perforation of gastric ulcer and review the literature. CASE REPORT:A 65yr old driver was seen in the hospital with a 4- day history of epigastric pain which became generalized. Examination revealed a patient in shock with a board-like rigidity of the abdomen. Chest x-ray confirmed pneumoperitoneum. He had an exploratory laparotomy. Findings at surgery include moderate peritoneal fluid collection and 1.5cm diameter perforation on the posterior gastric wall which was closed primarily with an omental patch. Biopsy of the ulcer edge was negative for malignancy. He was discharged 10 days after surgery. CONCLUSION:To the best of our knowledge,perforation of a posterior gastric ulcer is an unusual encounter in surgery.A high index of suspicion is needed to prevent high mortality.