The duodenum is c -shaped structure located in upper abdomen and subdivided into superior , descending , horizontal and ascending part. The ascending part (fourth part, D4) runs cranially along the left side of the vertebral column and aorta as far as the level of the upper border of second lumbar vertebra. It is retroperitoneal, less mobile and surrounded by suspensory muscles of the duodenum which helps to stabilize the jejunum (1). Duodenojejunal flexure is a common location for traumatic bowel perforation mainly by shearing forces due to its relative fixity. Spontaneous free perforation of the DJ is uncommon, especially if there is no prior history of visceral trauma (2).The incidence is reported as 1 in 3.5 lac individuals.Pathological etiology like ulceration leading to perforation is rare, and no cause may be found. (3)Obstruction and inflammation of the bowel are most common causes of nontraumatic intestinal perforation in industrialized countries, whereas infectious causes are more common in developing countries (4). In cases of non traumatic perforation, management depends on the circumference of perforation and the contamination. Primary suturing with either NJ tube or feeding jejunostomy may be the preferred modality of choice. Recent evidencealso supports this modality of end to end anastomosis or primary closure in which anastomosis or primary closure is recommended and thesurgical area be kept dry either by nasogastric tube, nasojejunal tube and feeding jejunostomy. (5, 6) We report a case of retroviral positive patient with non-traumatic perforation at the D-J flexure in a45-year-old male.