This report describes an uncommon condition, nonocclusive mesenteric ischemia (NOMI) in a patient with end-stage renal disease on continuous peritoneal dialysis therapy. The patient presented with nonspecific abdominal symptoms and leucocytosis which later progressed to an acute abdomen due to generalized peritonitis of unknown origin. She had been hospitalized with an episode of hypotension four days before surgery. At emergency laparotomy, we detected an unusual form of ileal infarction that was characterized by multiple, variable sized and patchy-looking necrotic areas, of which a few were perforated. We resected the infarcted ileal segment, and did a proximal ileostomy. The patient was as well as she could be in relation to her chronic renal disease. We emphasize the need for surgeons to consider NOMI as a cause of peritonitis in patients with renal failure.