Patients with an anteriorly perforated peptic ulcer present with an acute onset of severe abdominal pain and exhibit signs of peritonism at presentation. Diagnosis of an acute abdomen can often be made on clinical grounds and an emergency operation performed. Posterior perforation of gastric ulcer is a unique category of peptic ulcer perforations with a distinct clinical presentation (1). While it is rare, awarencess of this surgical emergency is important, as this condition is associated with a high morbidity and mortality. The diagnosis is commonly missed because of the indolent nature on the initial symptoms with catastrophic outcome. We report a case of posterior perforation of gastric ulcer and review the literature to highlight the key features of this condition.