Perforation peritonitis in India has a different spectrum as compared to the western countries and requires urgent surgery. Here, we presented a case of perforation peritonitis of 58 years old female. The patient suffered from severe abdominal pain, mild distention with generalized guarding and marked rebound tenderness around the umbilical region. She was diagnosed as perforated peritonitis. The patient underwent Exploratory Laprotomy with modified grahams procedure and initiated early ambulation post- operatively. She stayed in the hospital for 7 days,during which the patient\'s health improved and feels comfortable. Case Report: Mrs. Neelavathy, housewife, 58ears old got admitted in female surgical ward on 21.01.2019 with a complaints of severe abdominal pain, vomiting and abdominal distension for the past 6 days. On admission she was conscious and oriented. On examination she was afebrile, pulse- 88 beats/min, blood pressure 120/78 mm of Hg and respiratory rate of 20/min. Abdominal examination findings revealed severe abdominal pain, mild distention with generalized guarding and marked rebound tenderness around the umbilical region. There were no palpable masses and bowel sounds were absent. No family history of communicable disease, hypertension and DM. Basic investigations includs random blood sugar- 180mg/dl, Sr. urea- 40 mg/dl, Creatinine- 1.8 mg/dl, sodium- 136 mg/dl, potassium- 4.0 mg/dl, chloride 101mg/dl, Hb 10 mg, PT- 16.8 seconds, INR- 1.381 , CBC, sr. electrolyte and grouping were done. Ultrasound abdomen suggested free fluid in The abdomen cavity . On the basis of history collection , physical examination, she was diagnosed as Perforated Peritonitis . The patient was kept nil per oral, IVF started initiated and on 22.01.2019 underwent for Exploratory Laprotomy under general Anaesthesia and initiated early ambulation post- operatively. She was on Inj. Cefataximine 500 mg IV q6h, Inj. Octrotide 50 mcg s/c OD, Inj. Emeset 8mg bd .