Background: Acute abdomen is one of the most common causes of emergencies which present to surgeon and one the most common cause for it is Perforation peritonitis and timely management of it can prevent morbidity and mortality, its important to reach the diagnosis earliest and intervene immediately.Most of the time when patient presents to the tertiary centre, it is by clinical examination and investigation a diagnosis of perforation is established. The objective of the study was to evaluate causes, signs and symptoms, various modalities of management and possible complications which develop in gastrointestinal perforations. Methods: This study comprises of 40 consecutive cases of acute perforation peritonitis on whom exploratory laparotomy was done. With study period of 18 months conducted by Department of General surgery, Basaveshwar Teaching and General Hospital ,Kalaburgi. A complete detailed history, physical examination, relevant blood and radiological investigations were done. After that, patients were operated, preoperative findings were correlated with intra operative and radiological findings. Results: Gastric perforation was the most common cause of perforation accounting for 37.5% of cases. Surgical site infection was common complication . Conclusion:The standard of care for all perforations is surgery.