Objective: To assess the value of gastrografin (meglumine diatrizoate) contrast in diagnosis of upper gastrointestinal (GI) tract perforation. Methods: The clinical data of 112 patients with clinically suspected upper GI tract perforation who underwent gastrografin contrast examination were retrospectively analyzed. The patients were dynamically observed by fluoroscopy to determine whether there was leakage of the contrast agent from the stomach or duodenum and x-ray films were taken for analysis. The result was positive for upper GI tract perforation if contrast agent leakage was present and vice versa. Results: All the 112 patients underwent gastrografin contrast examination, of whom 72 cases had positive findings that included 31 cases of stomach perforation (27 cases of perforated gastric ulcer and 4 cases of perforated gastric cancer) and 41 cases of duodenal bulb perforation due to peptic ulcer. Of the remaining 40 patients with negative finding, 39 cases were identified to have other diseases by CT, emergency gastroscopy examination or exploratory laparotomy, but one case was found to be perforation of the posterior gastric wall on exploratory laparotomy. The coincidence rate of gastrografin contrast examination in diagnosis of upper GI tract perforation was 99.1%, and the sensitivity and specificity rate was 98.6% and 100%, respectively. No false positive case was found but there was one false negative case in the whole group. Conclusion: Gastrografin contrast has important application value in diagnosis of upper GI tract perforation, as it is safe, effective, and of relatively low cost.