Context: Large bowel perforation is mostly seen in association with colorectal carcinoma. Diverticulitis is a common cause for large bowel perforation in the west while it is rarely seen in India. Recent studies advocate a primary procedure in the setting of large bowel perforations. Aims: The study was done to study the etiology, management and outcome of large bowel perforations. Settings and Design: This was a prospective observational study. Methods and Materials: The study was conducted over a period of three years including 24 patients with large bowel perforations who underwent exploratory laparotomy. Surgical procedure was planned on basis of Mannheim Peritonitis Index (MPI). Outcome in terms of mortality rate during index admission was evaluated. Statistical analysis used: The Chi square test and student’s t test were used for qualitative and quantitative variables respectively. The factors found significant on Univariate analysis were assessed in a multivariate analysis. Results: Colorectal carcinoma was the most common aetiology present in 12 (50%) cases. Hartmann’s procedure was done in 17 (70.9%) patients. Primary anastomosis was done in 4 patients and all of them faired well post-operatively. On multivariate analysis septic shock at presentation (OR=23.3, 95% CI=1.7-2.0, p<0.001) and MPI>35 (OR=17.8, 95% CI=1.5-1.9, p=0.006) were found to be the significant factors associated with mortality. All the bacterial isolates in peritoneal fluid culture samples were extended-spectrum betalactamase (ESBL) producing species. Conclusion: A primary procedure can be safely carried out in patients of large bowel perforation with a low MPI. MPI serves as useful guide to plan surgical procedure and predict the outcome.