Gastric perforation in the elderly is mostly treated by surgery, and conservative treatment can be given to the elderly who cannot tolerate surgery and whose condition is mild, including fasting and water intake, gastrointestinal decompression, acid suppression, anti-infection, rehydration and other treatments. Gastric perforation is a pathological change caused by the penetration of the stomach wall and the entry of gastric contents into the abdominal cavity. It is often triggered by a history of gastric ulcer, gastric cancer, or under stress, trauma, drug stimulation, etc. It often manifests itself as a sudden, persistent and severe abdominal pain, which spreads to the whole abdomen very quickly, and it can also show shock manifestations such as pallor, cold limbs, and cold sweating, etc., and some of the elderly people do not have any obvious symptoms. Treatment is mostly surgical, and gastric perforation repair is feasible. However, conservative treatment can be used for those with small perforation, little exudation, not serious condition or tendency of limitation. There should be strict abstinence from drinking and fasting, continuous gastrointestinal decompression, drugs including acid-suppressing drugs such as omeprazole, broad-spectrum antibiotics such as ceftazidime, piperacillin, ciprofloxacin, etc., and when accompanied by shock, pressor drugs such as norepinephrine and dobutamine can be used. In the clinic for the elderly gastric perforation must pay great attention to, because the elderly’s ability to react is poor, usually appear symptoms when the condition has been more serious. It is necessary to consult the doctor in time, and under the guidance of the doctor’s treatment.