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Background: The aims of the study were to find whether a decrease in absolute eosinophil count was a reliable prognostic marker in patients with perforative peritonitis and to determine whether the levels of Absolute eosinophil count had any correlation with the type of perforation.Methods: A total of 104 patients with perforative peritonitis presented consecutively to Madras Medical College, Rajiv Gandhi Government General Hospital from October 2017 to October 2018 were chosen and were allocated into two groups based on the outcome as mortality or survival. 88 patients were in the survival group and 16 patients were in the mortality group. The Absolute eosinophil count distribution in both these groups were recorded along with the type of perforation.Results: Data were processed using SPSS software. All values were expressed as mean±standard deviation / median. Comparison of absolute eosinophil count between the two groups was done using student ‘t’ test and prognostic accuracy of the parameters were done using ROC curve analysis. It was found that a decrease in absolute eosinophil count was associated with adverse outcome in perforative peritonitis patients.Conclusions: From this study, we conclude that Absolute Eosinophil Count is a reliable marker of survival. It allows timely identification of high-risk patients and can be used as a marker for risk stratification and hence can be considered a reliable prognostic marker in perforative peritonitis patients. It can also be concluded that there is no correlation between the Absolute eosinophil count levels and the type of perforation.