Ulcerative ischemic lesions of the small bowel represents a rare abdominal pathology. We present the case of a 68-year-old male who was admitted to our hospital for abdominal pain, nausea and vomiting. Ultrasound examination followed by upper endoscopy raised up the suspicion of a jejunal ulcerative perforated lesion. Surgery confirmed the diagnosis, revealing the jejunal ulcer, perforated and blocked by the adjacent enteral loops. Ischemic etiology of the ulceration was indicated by the mesenteric thrombus. The anatomopathologic finding together with the clinical and imagistic examinations lead us to the diagnosis of thromboangiitis obliterans, cause of the mesenteric ischemia; the future problems regarding this case are the long term follow up, in order to be able to recognise the visceral ischemic recurency that might occur.