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Recurrent bladder perforation due to xanthogranulomatous cystitis with malakoplakia is rare entity and can lead to spontaneous bladder perforation. A 15 years girl presented with sudden pain abdomen with reduced urine output. Her exploratory laparotomy revealed, perforation of 2 cm at the dome of bladder with unhealthy margins. Excisional bladder biopsy and repair of bladder perforation by 3-0 polyglactin suture was done. The histopathology showed xanthogranulomatous cystitis with malakoplakia. Her records revealed the same histopathology in bladder perforation at age of 9 with lost follow-up till age of 15. Exploratory laparotomy and bladder repair should be done to save the patient.