A 74-year-old woman with longstanding diarrhea and clinical symptoms of malabsorption and a raised peripheral eosinophilic count underwent an explorative laparotomy for small intestinal perforation. The resected specimen was consistent with the diagnosis of eosinophilic gastroenteritis. Despite corticosteroids, a second acute abdominal crisis occurred and the patient died. Small intestinal perforation due to transmural bowel wall involvement in eosinophilic gastroenteritis has to our knowledge not been described previously.