Background: Perforative peritonitis (PP) is one of the commonest surgical emergencies in Asian countries and India. The PP aetiology in Asian countries remains different from Western countries. Aims and Objectives: The study was aimed at highlighting the spectrum of PP as encountered by us at BRD Medical College Gorakhpur. Materials and methods: Three hundred patients who were admitted in surgical ward of BRD Medical College, Gorakhur were studied from September 2015 to October 2016. All the subjects of this cohort were diagnosed with PP. Results: In this study 300 cases of PP were included, this cases accounts for 25% of total surgical abdominal emergency admissions. With 44% cases of duodenal perforation was the commonest reported cause of PP. Morbidity and mortality were directly associated to the time period between emergence and surgical intervention and most importantly the amount of contamination in peritoneal cavity. Other interpreters were co-morbid situations, site of perforation, post-operative complications and older age of the patient. Mortality rate was 14%, highest in duodenal perforation and least in appendicular perforations. Conclusion: Better understanding of aetiological factors, prompt medical facilities and good postoperative care needs are essential improve the outcome reduce mortalities.