Large posterior perforation of duodenal ulcer: A rare surgical emergency

A 20-year-old man was admitted with a complaint of a constant dull aching pain in the epigastrium and back for five days, with subsequent worsening and generalization of the pain. Clinically the abdomen was tender all over with board-like rigidity. Chest radiography revealed pneumoperitoneum, and a decision was made to explore the patient. During laparotomy, we found a peritoneal collection with no perforation in the anterior surface of the stomach, duodenum, or the entire gastrointestinal tract. After opening the lesser sac, we found a large perforation of the posterior wall of the duodenum. After direct repair with stitching through duodenotomy and duodenoplasty also done, the patient recovered and was discharged after 14 days. Posterior perforation of a duodenum ulcer is a very rare condition.