AIM: The jejuno-ileal diverticulosis is an unusual disease which affects elderly people and its complications can be fatal due to delayed diagnosis. The most frequent complication of jejunal diverticulitis is the perforation. CASE REPORT: In this report we describe a case of elderly patient presenting with acute abdominal pain and fever. The patient underwent to an urgent exploratory laparotomy that revealed a perforated small bowel diverticulum. An intestinal resection with primary anastomosis was performed. DISCUSSION: Jejunal diverticulosis often presents with non-specific symptoms like intermittent abdominal pain, dyspepsia, bloating or abdominal fullness and constipation. When, instead, it incurs a complication, it presents with an acute abdominal pain. The most frequent complication of jejunal diverticulitis is the perforation, followed by acute intestinal obstruction and diverticular bleeding. The diverticular perforation is associated with a high mortality, especially among elderly patients. Nowadays the mortality is reduced because of the improvement of the diagnostic, pharmaceutical and surgical protocols. CONCLUSIONS: With this report we want to discuss about different therapeutic approaches for perforated jejuno-ileal diverticula, which depends on the severity of the disease and the general clinical condition of the patient.