Posterior gastric perforation is a rare surgical emergency. An 80-year-old patient was admitted with complaints of pain in the epigastric region for two days with features of dehydration and shock. Outside CT abdomen was suggestive of pneumoperitoneum along the lesser sac. Exploratory laparotomy was performed, and perforation was found along the posterior gastric wall near the antrum. Grahm's omental patch repair was done. The patient recovered and was discharged after two weeks.
Key words: Gastric ulcer, posterior perforation, lesser sac, pneumoperitoneum