1. By: Sagiran Dept. of Surgery Faculty of Medicine Muhammadiyah University of Yogyakarta

2. Background Central Statistics Agency of Indonesia surveillance revealed that the number of elderly in Indonesia as many as 17.717.800 people, or 7.90%. Some diseases that often affect the elderly are physical disorder, mental, and environmental factors can cause the elderly less mobile. The most common cause is a disorder of the bones, joints and muscles, neurological disorders, and diseases of the heart and blood vessels.

4. The chief of complaint as clinical manifestation in elderly to look for medicine is pain. It causes many cases of irrational self medication. To relief pain the use un-prescribed medicine and herbs mixed by NSAIDs or even steroids.

5. Finally, they fall into severe side effect of long-term usage of NSAIDs i.e. gastric irritation, damage the stomach lining, ulcers and perforation. Peritonitis

6. Risk factors for secondary peritonitis include: 1. Appendicitis (inflammation of the appendix) 2. Stomach ulcers 3. Torn or twisted intestine 4. Pancreatitis 5. Inflammatory bowel disease, such as Crohn's disease or ulcerative colitis 6. Injury caused by an operation 7. Peritoneal dialysis 8. Trauma

7. Material and Method This paper presented 5 cases series of patients suffered from peritonitis due to gastric perforation by this year in PKU Muhammadiyah Hospital of Yogyakarta. The age ranged from 61-75 y.o. They use a medicine suspicious containing NSAIDs or Steroid such as jamu oplosan (traditional Javanese herbal mixture remedy) for 3,5 years in average (ranged 2-5 years). Also they use OTC products of anti-inflammatory from drug store. They are all active smoking, and come from middle-low economic and un-educated people.

8. All of the cases underwent exploratory laparotomy. They have been treated with excision, primary suture and omental patch, with histological findings showed perforated peptic ulcer (majority gastric perforation). The anthro-pyloric region is the most common site of perforation. Four patients survive and discharged from the hospital in day 7 after operation. One patient passed away after 10 days caused by severe sepsis and multi organ failure.

9. Discussion Briand pollah and Agus Rahardjo (UNS Surgery Fac. of Medicine / Hospital Dr. Moewardi, Surakarta) reported from the years 2006- 2010 in the case of Generalized Peritonitis e.c. Gastric Perforation found as many as 73 cases, of which 54 (73.9%) were male and 19 (26.0%) were women. They are 9 (12.3%) aged 40-50 years, 38 (52.0%) aged 51-60 years, 15 (20.5%) aged 61-70 years and 11 (15.0%) at age> 70 years.

10. In Bali from 9 July 2010 to 31 January 2011, at the emergency room of Sanglah General Hospital, it has been found 13 cases of Peritonitis e.c. Gastric Perforation. They are 6 cases found in male patients and 7 female patients.

11. Conclusion and recommendation These findings showed that many factors affecting the incidence of gastric perforation. The government should develop program to take over this problem.

12. It is too late Perforation

13. It will be multi-professionals and inter-disciplines approaches.