Key Clinical MessageWe report a case of an extremely rare perforated early-stage gastric cancer for which curative resection was performed after conservative treatment. Depending on the patient’s general condition, degree of peritonitis, tumor status, and curability, conservative treatment or minimally invasive treatment should be performed for perforated gastric cancer. After improved general condition and adequate assessment of gastric cancer, gastrectomy with lymph node dissection was suitable, which may lead to a highly curative surgery and improved prognosis.Keywords: early gastric cancer; gastric perforation, conservative therapy