Background: – Ileal perforation is a common problem seen in tropical countries. Ileal perforation is due to many causes, the most common being Enteric fever, Tuberculosis. Trauma continues to be the most frequent reason for high morbidity and mortality. Materials and methods: This is a randomized comparative study conducted in general surgery department of ACSR GOVT. Medical College and Hospital, Nellore between August 2016 to September 2018. All the patients were followed up closely for post operative complications Results: Twenty eight patients of ileal perforation belong to various ages , both sex and from different causes were observed postoperatively between August 2016 to September 2018 .The post operative results showed the following as the different causes of perforations. Out of 28 ileal perforations treated, fifteen (53.57%) patients had typhoid perforation, seven (4.76%) were nonspecific, five (17.85%) were traumatic, one (3.57%) was due to tuberculosis Conclusion: Early surgery and adequate resuscitation are the important factors for successful management of patients with ileal perforation. This study proposes that ileostomy may be given priority over other surgical options especially in those moribund patients who present late in the course of their illness, have more than one perforation with massive faecal contamination of the abdominal cavity.