Background:Peptic ulceration occurs due to acid peptic damage to the Gastroduodenal mucosa, resulting in mucosal erosion that exposes the underlying tissues to the digestive action of Gastroduodenal secretions. It affects 4 million people worldwide annually and its lifetime prevalence in patients with Peptic ulcer disease is about 5%. Objective:The objective of the study is to assess the proportion and associated factors for perforated peptic ulcer disease among adult patients with non-traumatic acute abdomen who were admitted to surgical ward and operated at Debre Tabor Comprehensive specialized Hospital from January2020 to January 2022 G. C Methods:Hospital based retrospective cross sectional study was conducted at Debre Tabor Comprehensive specialized Hospital from January 2020 to January 2022 G. C on 455 adult patients with non-traumatic acute abdomen who were admitted to surgical ward and operated.The charts of patients were selected using a systematic random sampling technique. A structured research tool was used to collect all the necessary data from the patients’ medical records. The data were analyzed by using SPSS version 25. Frequencies with percentages were used to describe Peptic ulcer disease and associated factors among non traumatic acute abdomen. The bivariable and multivariable logistic regression model was used to explore the determinant factors associated with peptic ulcer disease among non traumatic acute abdomen. Factors at P<0.25 from bivariable and P<0.05 from multivariable were declared statistically significant. . Results:A total of 455 cases were studied. Of which, 53.0%, 22.2%, 10.8% and 8.8% of the cases were acute appendicitis, small bowel obstruction, large bowel obstruction and perforated PUD respectively. Males were 75.0% (30/40) and outnumbered females by a ratio of 3: 1. Their mean age at presentation was 31.85+ SD of 12.7 years. All of the perforations were located on the first part of the duodenum in 100% of the cases and becomes the fourth commonest cause of acute abdomens next to acute appendicitis and small bowel obstruction. The factors significantly related to perforation were males,history of dyspepsia, drinking alcohol and treatment delay (P < 0.001). Conclusion:Acute perforation of peptic ulcer continue as one of the real emergency condition in Debre Tabor Comprehensive Specialized Hospital requiring immediate attention and prompt operation. It developstwenty one, twenty five and twenty eight times on dyspeptic, alcohol drinkers and late presenters respectively. Thus, peoplewith such behaviour must inform about this by health education and enforce to bring life style change to get out of risk.