Laparoscopically Repaired Posterior Benign Gastric Wall Perforation – A Rare Case Report

Gastric perforation, most commonly caused by peptic ulcer disease (PUD), is a surgical emergency. While perforations are generally found in the anterior aspect of the duodenum, only 5–8% involve the posterior wall of the stomach. Posterior perforations represent a rare and distinct clinical entity, with an estimated annual incidence of 3.8–14 cases per 100,000 individuals. Pre-operative diagnosis can be challenging, as these perforations are often identified only during surgery. Posterior perforation of peptic ulcer is a distinct clinical entity not commonly encountered. We present a case of a 28-year-old male who presented to the emergency with complaints of severe epigastric pain radiating to the back for 12 hours with shock. Initially, a diagnosis of Acute Pancreatitis was assumed clinically but only after contrast-enhanced CT imaging, the diagnosis of Posterior gastric wall perforation was made. Following resuscitation, the patient underwent a Diagnostic Laparoscopy due to the diagnostic uncertainty. Intraoperative findings revealed a 1x1 cm perforation located on the posterior gastric wall, approximately 6 cm from the pylorus. The perforation was laparoscopically repaired using an omental Graham patch, accessed via the lesser sac through the supracolic compartment. The patient made an uneventful recovery and was discharged on postoperative day 7 with dietary advice and a follow-up plan.