BACKGROUND Peptic ulcer perforation is a serious complication of peptic ulcer disease with a significant morbidity and mortality. OBJECTIVE To evaluate 76 patients operated for peptic ulcer perforation and analyse the associated factors in Zewditu Memorial Hospital, Addis Ababa from September 2006 to August 2008. METHODS A retrospective analysis of medical records of 76 patients who were operated up on for perforated peptic ulcer over a two year period (2006-2008). RESULTS The male to female ratio was 6.6:1 with a mean age being 31.5 years. The most common presenting symptom was abdominal pain in 76 (100%) patients. History of smoking and khat chewing was documented in 53/64 (82.8%) and 48/64 (75%) of the patients respectively. Twenty five per cent of the patients gave no history of previous peptic ulcer disease. Seventy patients (92.1%) presented after 48 hours of their illness. The mean hospital stay was 14.5 days. Leucocytosis was found in 31.6% of the cases. Sixty five (85.5%) patients had duodenal ulcer perforation. Postoperative complications occurred in 24 (31.6%) patients. Twelve (15.8%) patients died in the hospital. CONCLUSIONS Early presentation of patients and change in life style may reduce morbidity and mortality in patients with peptic ulcer perforation.