Perforative peritonitis is one of the most serious and most overwhelming catastrophic conditions that can befall a human being and hence they should be treated energetically. The objective of the study is to highlight the etiology, clinical presentation and management and outcomes of the patients diagnosed and treated asperforativeperitonitis. A retrospective study was done on 567 patients diagnosed and treated as perforative peritonitis at our institute for a period of 3 years from January 2013 to December 2015. Patients who are all above 15 years of age provisionally diagnosed as perforative peritonitis and thosesurgically managed were included in this study. In this study maximum incidence of perforative peritonitis was seen in age group of 41-50 years with mean age of 45 of which 88% were males. In this study, the over all most common site of perforation was 1st part of duodenum (76%). In 92% of patients abdominal pain was the most common clinical presentation. X ray abdomen erect revealed air under diaphragm in 64.6% of patients with perforation. In rest of the patients CT scan was taken and in which free fluid, pneumoperitoneum, fat stranding, localized air pockets were the positive findings in diagnosing perforation. 96%of the patients were managed primarily with surgery, 4%were initially managed with flank drain and later were taken up for surgery. The overall mortality was about 22.04%. Most common cause of death was septicemia. In this study the most common post-operative complications was wound infection. Aim of the study • To evaluate the incidence of perforative peritonitis in relation to age/sex. • To evaluate the etiology of perforative peritonitis. • To study the incidence of site of perforation in perforative peritonitis. • To enlist the clinical presentation of patients of perforative peritonitis • To know the significance of investigative procedures in diagnosing perforative peritonitis. • To study the outcome of surgical management of perforative peritonitis