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Jejunal diverticulum enterolith causing perforation and upper abdominal peritonitis. A patient presented with a 4 h history of acute onset, progressive upper abdominal pain. There was localised peritonitis, with raised inflammatory markers and lactate. CT scan showed a large calcified mass, with evidence of mesenteric twist/volvulus causing some degree of small bowel obstruction. At laparotomy, there were multiple jejunal diverticula, one of which had perforated due to a large enterolith. Resection of the affected jejunum and washout was performed and the patient recovered well. Complications of jejunal diverticula and enteroliths are reported and should be considered in patients with an acute abdomen.