Background: Peptic ulcer disease (PUD) remains a common outpatient diagnosis. With the advent of proton pump inhibitors, improved hygienic conditions, and developing healthcare regimes, the prevalence of PUD has been decreased. However, the incidence of emergency surgery and the mortality associated with PUD has not decreased nearly so dramatically. Perforated peptic ulcer (PPU) represents the most frequent indication for emergency surgery for PUD. Accurate and early identification of high-risk surgical patients with perforated peptic ulcer (PPU) is important for triage and risk stratification. Therefore scoring systems have been developed to be used for prediction including (Boey, PULP, ASA, POMPP and MPI).