Ileal perforation is a common complication of Typhoid in developing countries other causes includes tuberculosis, trauma, and enteritis. Non-traumatic perforation is a challenge for surgeons because of considerable morbidity and mortality. This study tried to evaluate the etiology and clinical outcomes of surgical management for all the cases of non-traumatic ileal perforation. This prospective cross-sectional study was conducted in the Department of General Surgery, Prathima Institute of Medical Sciences, Naganoor, Karimnagar. Inclusion criteria were all the patients above 15 years undergoing surgery for ileal perforation. Excluded patients were those with appendicular perforations, peritonitis, and traumatic perforations. Based on the inclusion and exclusion criteria of 21 male and 17 female patients were included in the study. A thorough clinical examination of the patient including vital signs, abdominal distension, guarding and tenderness was done and noted. The laboratory investigations included Hemoglobin, BT & CT, and serum creatinine. Chest X rays, ECG, Blood culture and WIDAL tests were done to diagnose patients with typhoid. Results: In the present study out of 22 male patients 17 were diagnosed with typhoid perforation and 5 were a non-specific perforation. In the 17 females, 15 were diagnosed with typhoid perforation and 2 were non-specific perforations. The surgical approach for the management included primary closure in the total of 25 (64.10%) male and female patients followed by Ileostomy in 8 (20.51%), Ileo Transverse Anastomosis in 4 (10.26%) and resection anastomosis in 2 (5.12%) of cases. Conclusion: Within the limitations of the present study it can be concluded that typhoid ileal perforations are common in the group of patients reaching our hospital. The operative treatment for intestinal perforations should be based on several factors including operative findings. Early surgery with skilled surgeons and good postoperative care will result in reduced morbidity and mortality.