Jejuno-ileal diverticulosis is an uncommon small bowel disorder, predominantly affecting elderly individuals. Although often asymptomatic, it may present with nonspecific symptoms or progress to severe complications such as perforation, obstruction, or hemorrhage. Due to its rarity and vague presentation, diagnosis is frequently delayed, increasing the risk of morbidity.

A 79-year-old woman with a history of multiple abdominal surgeries presented with intestinal obstruction secondary to a strangulated right femoral hernia. Laparoscopic repair was performed successfully. Four days later, she developed recurrent obstruction unresponsive to conservative treatment. Re-exploration revealed multiple jejunal diverticula with a localized perforated diverticulitis. Segmental small-bowel resection with primary anastomosis was performed. The postoperative course was complicated by an anastomotic fistula and stercoral peritonitis, requiring reoperation and a double-barrel ileostomy. After stabilization and infection control, intestinal continuity was restored one month later with complete recovery.

Jejunal diverticulitis remains a diagnostic and therapeutic challenge. Computed tomography is the modality of choice for identifying diverticular perforation or abscess. While conservative management may suffice for localized inflammation, segmental resection with primary anastomosis remains the treatment of choice for perforation or peritonitis. Laparoscopic approaches, when feasible, offer diagnostic precision, reduced invasiveness, and faster recovery.

Early recognition of jejunal diverticulitis and timely surgical intervention are essential to reduce morbidity and mortality. This case underscores the importance of maintaining a high index of suspicion for small bowel diverticular disease in elderly patients presenting with acute abdomen, ensuring prompt and individualized management for optimal outcomes.