• Analysis of 100 consecutive cases of posterior perforating peptic ulcer revealed that a patient with the presenting symptom of pain, particularly steady, continuous, and severe in the upper part of the abdomen or lower thoracic or back regions, often bizarre and not characteristic of ulcer pain, may well have a posterior penetrating peptic ulcer. The first indication of the presence of a peptic ulcer may be the symptoms caused by perforation. The location or even the presence or absence of pain due to a posterior perforating peptic ulcer is dependent upon the depth of perforation into the pancreas. When the diagnosis has been established clinically and intractability is apparent, surgical intervention should be undertaken as early as possible to relieve the patient of his severe pain and also to avoid more serious complications associated with the pancreas.
Adams HD, Ross JR. POSTERIOR PERFORATING PEPTIC ULCER. JAMA. 1957;164(18):2009-2012. doi:10.1001/jama.1957.02980180011003