Acute appendicitis is the most common surgical emergency, with16% of the population undergoing appendectomy. Burst appendix is one of the complications of acute appendicitis and occurs 25% cases that is associated with increased morbidity and mortality and hence regarded as a surgical emergency.1 This study focuses on the pattern of presentation, risk factors, accuracy of clinical diagnosis, morbidity and mortality of patients managed for perforated appendicitis in DMCH. This observational study was carried out in the department of surgery, Dhaka Medical College Hospital, Dhaka, from January 2012 to December 2012.Total 200 cases of suspected burst appendicitis were included in this study. Among the 200 cases of suspected burst appendix patients, majority of the cases 48% were of 25 – 34 years age group. Most of the cases 71% were male and 29% were female. Higher income group of patients are less sufferer 8%, origin of pain from umbilicus 74.50% and from RIF 25.50%, nausea in 71.89%, vomiting in 64.05%, anorexia in 32.67%, fever in 50.32%, diarrhea in 5.22% and abdominal distension in 8.49% cases. Tenderness over RIF was present in 100%cases, rebound tenderness was present 80.39% cases, rigidity over RIF was 84.96% patients, Cough test was positive 54.90% cases, Diffuse abdominal tenderness in 87.58% cases, Abdominal distention in 13.07% cases and absent of bowel sound in 40.52% cases. Maximum number of patients reported after 3-4 days of onset of symptoms. Ultrasonogram shows normal findings in 55.56% and suggesting ruptured appendicitis in 44.44% cases. Operative findings of those patients, 33.33% cases presented with only burst appendix without local sequel and 35.29% cases present with generalized peritonitis, 13.73% cases present with localized peritonitis, 10.46% cases present with localized abscess, 5.23% cases present with periappendiceal fluid collection and extraluminal appendolith present in 1.96% cases. Burst appendix present a challenge to the clinicians because it can be delay in diagnosis, result in delay in operation and can be developed fatal complication. So we emphasize on careful history taking and physical examination in such cases can make the difference between life and death.