Recurrent Perforation of a Gastric Ulcer with Retroperitoneal Extravasation: Report of a Case

Abstract

Perforation of a peptic ulcer (PPU) is one of the major complications of peptic ulcer disease (PUD). Posterior PPU is rare, the diagnosis is difficult, and the mortality is high. We report an 80-year-old man admitted with abdominal pain and melena who had a posterior perforation of a gastric ulcer 3 years previously. On abdominal examination, he had muscle guarding and peritoneal signs. There was no free air under the diaphragm on an upright chest x-ray. Esophagogastroduodenoscopy (EGD) showed an ulcer on the posterior wall of the antrum containing a hole with a sharp margin. Abdominal computed tomography (CT) showed a dirty appearance of the mesenteric fat and a bizarre bowel air pattern around the mesenteric vessels. An emergency operation was performed, and the gastric ulcer that had perforated retroperitoneally was repaired. If initial plain x-rays are unrevealing in a patient with significant symptoms and signs that may be attributable to PPU, further examination by abdominal CT is indicated.