Background: Perforation peritonitis is one of the commonest emergencies encountered in surgical patients in India. The etiology of this condition in tropical countries is different than those from the western countries. Present study highlights the spectrum of perforation peritonitis seen in the Department of General Surgery in Bundelkhand Medical College, Sagar (M.P). Methods: A prospective cum retrospective study was performed on 340 patients of perforation peritonitis over a period of 2 years in the Department of General Surgery in Bundelkhand Medical College, Sagar (M.P). cases were reviewed in terms of clinical presentation , operative findings and post operative course. Results: The commonest cause of perforation peritonitis in our series was NSAID Ingestion, followed by enteric, traumatic, appendicular and tubercular perforations. The overall mortality rate 7% was comparable to the mortality rates of other published series. Conclusion: Gastric perforation continues to be the commonest cause of perforation peritonitis, which is in contrast to the western world where lower Gastrointestinal perforations are more common. Besides, a significant number of traumatic perforations are due to increase in the number of high speed motor vehicle accident cases in last few decades