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Perforation of duodenal diverticulum is a rare occurrence but has a potentially fatal outcome. It is a difficult surgical problem because of delayed diagnosis and the attendant risk of duodenal fistula following primary repair. We present a case of posterior perforation of duodenal diverticulitis, diagnosed on computed tomography and successfully repaired with a Roux loop duodenojejunostomy. We also discuss the rare pathology, diagnosis and surgical options with special reference to this alternative form of mucosal repair.