Posterior Perforation of Gastric Ulcer with Giant Retroperitoneal Abscess – a Rare Case

Spontaneous perforation of a gastric ulcer is a rare entity and can often be overlooked considering the frequently silent clinical picture. The posterior erosion of the ulcer through the omental bursa in the retroperitoneal space determines local inflammation which, together with the fibrosis of the retroperitoneal tissue facilitates the enclosure of the gastric content. We present the case of a 49-year old patient investigated for pain in the upper abdomen. The endoscopy performed one month before the admission described a retractile area with a central ulcer on the posterior surface of the stomach, adjacent to the lesser curvature. Given the fact that the abdominal x-ray was normal, a CT scan was performed and a voluminous retroperitoneal cystic lesion was discovered. Combining all the preoperative information the diagnosis was of retroperitoneal abscess by posterior perforation of a gastric ulcer. Surgical intervention was performed, the abscess was evacuated and its wall was completely resected; because of local conditions a distal hemigastrectomy with Roux en Y gastro-enteroanastomosis was chosen over gastrorhaphy and omentoplasty.