INTRODUCTION: Spontaneous multiple small bowel perforation refers to the complete transmural disruption of the intestinal wall and is often associated with conditions such as inflammatory bowel disease, infectious enteritis, drugs or autoimmune diseases, and it affects all age groups. Spontaneous multiple small bowel perforations due to ischemic enteritis is a rare clinical entity. CASE PRESENTATION: A 75-year-old man was admitted to our hospital with acute abdominal pain, vomiting, low-grade fever, bloody diarrhea, and abdominal distension. He had no history of trauma, comorbidities, or medications. Erect chest X-ray showed air under the diaphragm on the right side. An emergency laparotomy was performed. Intraoperatively, ischemic lesions and multiple perforations were localized to the jejunum and ileum and sent for histopathology which showed features of ischemic enteritis. Finally, the patient's postoperative course was uneventful. CONCLUSION: While ischemic enteritis is uncommon, multiple small bowel ruptures are a rare but real complication.