Dissertation (MMED General Surgery)Peptic ulcer disease (PUD) is an erosion in the gastrointestinal mucosa with extension into muscularispropria. Peptic ulcer perforation is the second most common complication of PUD after bleeding peptic ulcers. There is paucity of data on magnitude and predictors of outcomes of perforated peptic ulcers among patients with acute abdomen in our setting and this study aimed to address such an existing gap. To determine magnitude and predictors of outcomes of perforated peptic ulcer among patient with acute abdomen at Iringa and Dodoma hospitals in Tanzania. This was a hospital based prospective longitudinal study conducted at Iringa and Dodoma regional referral hospitals from June, 2020 to december 2020. Acute abdomen wasdiagnosed based on history taking, physical examination, chest x-ray, abdominal ultrasound and perforated peptic ulcer confirmed at laparotomy. Surgical procedure performed, postoperative management and complications developed were all entered in the questionnaire, all patients were followed until discharge. Sample size was calculated using Kislie formula. Filled questionnaires were entered in statistical program and analyzed using SPSS version 25. Categorical variables were summarized into frequency and percentages, while numerical variables were summarized into means, median and standard deviation and a probability value (p-value) of <0.05 was considered to be statistically significant. Of 187 patients with acute abdomen 53 had perforated PUD giving a proportion of 28.3%. 32(60.4%) were males and 21(39.6%) were females giving a male to female ratio of 1.5:1.The patient’s ages ranged from 15 to 70 years with a mean age of 38.54±16.36. The peak age group was in the 4th decade (30-40 years). Comorbid conditions were present in 18(34.0%) of cases. NSAIDs use was observed in 13(24.5%) patients.Forty-three (81.1%) patients presented to hospital after 24 hours of perforation. Of those 48 who had x-ray done 34(71.0%) had pneumo-peritoneum on chest x-ray at presentation. Modified Graham’s patch was performed to 51(96.2%) and one patient underwent Billroth II partial gastrectomy. Post-operative complications occurred in 23(43.4%). 7 patients died giving a mortality of 13.2%. Perforated peptic ulcer has a higher magnitude among patients with acute abdomen in our setting. Timely presentation and management can reduce adverse outcomes. Advanced age, hyper or hypokalemia, long hospital stay and low hematocrit significantly predicted poor outcomes.