Aims & Objectives: Intestinal Perforations are most common surgical emergencies seen worldwide. Despite improvement in diagnosis, antibiotics, surgical treatments and intensive care support, it is still an important cause of mortality in surgical patients. This study was done to know the spectrum of etiology, clinical presentation, management and treatment outcomes of patients admitted with perforation peritonitis in our hospital. Methods: A prospective study was done over a period of 3 years from January 2011 to December 2013 in SMS medical college and hospital, Jaipur, Rajasthan which included 1400 patients diagnosed with perforation peritonitis. All patients admitted with perforation of gastrointestinal tract were included in this study. All cases of primary peritonitis and anastamotic leaks were excluded from this study. Results: Total of 1400 cases were included with 74.28% being males. The time taken for resuscitation, diagnosis and preparation of patient for surgery was less than 12 hours in 83.4% of cases. Most common symptom with which patient presented was abdominal pain(99%) followed by nausea (92%),vomiting(85%) ,abdominal distension(71%), fever(64%) and altered bowel habit(42%). 12% patients were in shock. Most common site of perforation noted was duodenum(35.8%) followed by ileum(27.6%). Gastroduodenal perforations were mainly caused by Acid peptic disease(93%).Jejunal by blunt trauma abdomen(96%), ileal by typhoid (64%) and tuberculosis(31%) and colonic by malignancy(77%). Primary repair was done in 49.6% cases. 11% cases required resection and anastomosis, 21% required resection without anastomosis and Appendicectomy was done in 18.4% cases. Overall mortality was 7.2%. Conclusion: In contrast to western literature, where lower gastrointestinal tract perforations predominate, upper gastrointestinal tract perforations constitute the majority of cases in India with APD, typhoid and tuberculosis being the commonest causes.