Despite the diminishing role of surgical management of peptic ulcer disease with the advent of effective medical anti-ulcer treatments i.e. H2 receptor blockers and proton pump inhibitors, peptic ulcer perforation is still a commonly encountered and serious life-threatening emergency associated with significant morbidity and mortality.

In the modern era, patients suffering from this complication are mostly middle-aged men, and showing rising trend towards increased age and comorbidities resulting in higher morbidity and mortality.

The current common practice in management is simple repair with omental patch. However, leakage after repair may occur and is associated with very high mortality.

Many risk factors have been investigated and incriminated in recurrence of leakage e.g. old age, associated comorbidities, pre-operative malnutrition and hypoalbuminemia, delayed presentation, presence of septic shock, extent of peritonitis, site and size of perforation.

Despite the numerous variable techniques and approaches of management that have been studied and tested for this condition, there is still paucity of consensus or unified protocols of management across surgical practice worldwide. In this review, we try to consolidate present evidence based publications into a simplified scheme of management.