CASE REPORT

Posterior Perforation of Gastric Ulcer - A Rare Surgical Emergency

Vijaykumar Kappikeri
Professor of Surgery, M R Medical College, Gulbarga

Abstract
Posterior perforation of gastric ulcer is a rare surgical emergency associated with a high mortality and morbidity. The diagnosis is commonly
missed. Very few cases have been reported in literature. Here, we report a case of posterior perforation of gastric ulcer which was operated
and discharged without any complications.
Keywords: gastric ulcer, posterior perforation, peptic ulcer perforation

INTRODUCTION
The most common site of peptic ulcer perforation is the was made. USG showed fluid filled bowel loops with free
anterior aspect of the duodenum. However, the anterior or fluid in peritoneal cavity. Blood investigations showed Hb
incisural gastric ulcer may perforate. In addition gastric 11.6gms%, Tc10, 300 Cells/cumm, Blood urea 101mg/dl
ulcers may perforate into the lesser sac, which can be and serum creatinine1.0 mg/dl.
particularly difficult to diagnose. The patients may not have
obvious peritonitis.1 Fig. 2: Showing posterior gastric wall perforation
Case report
A 58-year old female was admitted with complaints of pain
in the abdomen since 5 days, sudden in onset, progressive in
nature and distension since 3 days. Patient was febrile and
vitals were stable. On examination, abdomen was distended,
soft and tender, with absent peristalsis. There was no
rebound tenderness. Chest X-ray demonstrated
pneumoperitoneum and a diagnosis of perforated viscus

Fig. 1: Lesser sac opened to expose the perforation

Fig. 3: Lesser sac opened near the spleen

*Author Correspondence:
Dr. Vijaykumar Kappikeri, Professor of Surgery, Basaveshwara Hospital,
Gulbarga 585 105

RGUHS J Med Sciences, Jan 2013 / Vol 3 / Issue 1 63

Vijaykumar Kappikeri
An emergency laparotomy was done. On exploration,
moderate peritoneal fluid collection was present which was
drained out. No perforation was seen in the anterior surface
of stomach or duodenum. Rest of the gastrointestinal tract
was normal.
Is not obvious on exploration of the abdomen. The posterior
wall of the stomach by opening the lesser sac has to be
checked. Pneumoperitoneum when present is definite and
invaluable sign for evaluation of patients with posterior
perforation. It is also an indication for immediate surgical
exploration.
REFERENCES
1. Williams N, Bullstrode C, O'Connell R Stomach and
duodenum in Bailey and Love's Short Practice of Surgery
25th edn. London, Arnold Publishers, 2008:1062.
2. Zinner M, Schwartz S, Ellis H Maingot's Abdominal
Operations.10th edn. Appleton Lange. Prentice Hall
International. 1997:971,983.
Give sorrow words: The grief that does not speak whispers the o'er
fraught heart, and bids it break
RGUHS J Med Sciences, Jan 2013 / Vol 3 / Issue 1
Posterior Perforation of Gastric Ulcer - A Rare Surgical Emergency
3. Mercer DW, Robinson EK, Stomach in Sabiston Text Book of
Surgery Townsend CM, Beauchamp RD, Evers M, Kenneth
LM Mattox KLM (ed),17th edition. Saunders-Elsevier. USA.
2004: 1279, 1284.
4. Ho-Wona C, Chow PKH. Posterior perforation of gastric
ulcer. Digestive diseases and Sciences. 2004:49(11/12);
1882-3.
5. Hugh TB Perforated peptic ulcer. in Maingot's Abdominal
Operations.9th edn.Schwartz S, Ellis H(ed) Appleton &
Lange, USA.1990.
6. Ellis BW Perforated and obstructed peptic ulcer. Hamilton
Bailey's Emergency Surgery.12th edn. Oxford, Butterworth
Heinemann 1995: 359-62.
7. Ho Wong C, Chow PKH, Soo Ong, H, Chan WH, Lay Khin W,
Soo KC Posterior perforation of peptic ulcers: presentation
and outcome of an uncommon surgical emergency Surgery
2004:135;321-5.
- Shakespere, (Macbeth)
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