An 80-year-old man was seen at the hospital because of abrupt abdominal pain. The abdomen was board-like, and a simple X-ray film revealed free air. The patient was diagnosed as panperitonitis due to a perforated gastric ulcer. Emergency operation was carried out. During operation, a hard induration of 6cm in diameter with an 8mm perforation in its center was confirmed in the anterior wall of upper body of the stomach. Intraoperative fiberscope revealed a perforated advanced gastric cancer

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... N2S2) and gastrectomy with lymph node dissection was performed. Surgical specimen revealed that the moderately differentiated tubular adenocarcinoma invading the submucosal layer around the ulcer in the gastric wall. It was diagnosed as perforated early gastric cancer of type III +IIc histopathologically. In the diagnosis of gastric perforation, we should emphasize the importance to perform intraoperative frozen section diagnosis whenever possible and to follow post operative patients undergone simple suture by using gastric fiberscope. Forty-five cases of perforated early gastric cancer collected from the Japanese literature were also discussed.