The patient, a 63-year-old female, was transferred from an outside hospital to our hospital at 17:30 in the afternoon of May 2010 with “abdominal pain and bloating for 2 days with progressive worsening”. The patient had been diagnosed with “gastric adenocarcinoma” for the previous six months without any treatment. On admission, the patient’s heart rate was 170 beats/min, SaO2: 68%, Bp: 70/40 mm Hg. After emergency preoperative preparation, he underwent a total gastrectomy, esophagojejunostomy, jejunojejunostomy and jejunostomy for gastric cancer at 18:30 that night under general anesthesia. A 2.5*2.5 cm perforation of the anterior wall of the gastric sinus near the lesser curvature was found, and necrotic material was seen to be overflowing, the gastric wall was dark white with an uneven and hard surface, the mass involved the entire lesser curvature up to the cardia, and the surrounding enlarged lymph nodes were obviously fused. The diagnosis of acute diffuse peritonitis was clear. There were no obvious abnormalities in the liver, a large amount of pus and food residue in the subdiaphragm and pelvic cavity; there were no obvious metastases in the pelvic floor; the gastric cancer foci and lymph nodes could still be pushed, so it was decided to perform total gastrectomy, esophagojejunostomy, jejunojejunostomy and jejunostomy for gastric cancer. The operation went smoothly. During the operation, the patient’s blood pressure needed a lot of rehydration, blood transfusion and antihypertensive drugs to maintain, and the bleeding was about 200 ml. After the operation, the patient did not wake up and was directly sent to ICU for recovery from general anesthesia and intensive care and further anti-shock treatment. After the operation, the patient recovered smoothly and was discharged as scheduled. Features of this case: The patient was admitted to the hospital urgently with infectious shock and acute diffuse peritonitis, and her life was in danger, so the decision to operate was decisive.