Background: Early enteral nutrition has been increasingly recognized as a crucial aspect of postoperative care, particularly in patients with acute gastrointestinal perforations. Nasal feeding via a nasojejunal (NJ) tube may confer benefits such as faster return of bowel function, reduced infectious complications, and improved nutritional status. However, limited data exist on its efficacy in preventing septic complications in patients with upper gastrointestinal (GI) perforations. Methods: A prospective, randomized controlled study was conducted at the Department of General Surgery, Medical College Baroda and Sir Sayajirao General Hospital Vadodara, between September 2021 and November 2022. Sixty patients (age 18–70 years) with traumatic or non-traumatic perforations proximal to the ligament of Treitz were equally randomized into two groups: the Test Group (TG), receiving early enteral feeding via an intraoperatively placed nasojejunal tube starting 24 hours post-surgery, and the Control Group (CG), managed with conventional nil-per-os (NPO) until bowel function returned. Primary outcome was the incidence of septic complications. Secondary outcomes included change in nutritional status, length of hospital stay, compliance with NJ tube feeding, and mortality. Results: Early enteral feeding significantly improved postoperative nutritional parameters. Patients in TG demonstrated higher daily energy (p<0.05 from postoperative day 2 onward) and protein intake (p<0.05 from day 4 onward) compared with CG. Postoperative serum albumin on day 7 was significantly higher in TG (3.20±0.36 g/dL) versus CG (2.71±0.36 g/dL; p<0.05). Surgical site infection was significantly lower in TG (23.3%) compared to CG (50%; p=0.03). Overall length of hospital stay was reduced (13.82±3.5 days vs. 17.03±6.8 days; p=0.03). Mortality did not differ significantly between groups. Conclusion: Early enteral feeding through a nasojejunal tube in upper GI perforation patients is a safe, feasible strategy that significantly reduces septic complications (especially surgical site infections) and improves nutritional recovery. Early enteral nutrition should be considered a vital component of postoperative management in these patients.