57-year-old man presented to the emergency room with abdominal pain, nausea and vomiting. The symptoms started two months ago but became more severe over time. CT scan of the abdomen and pelvis showed partial small bowel obstruction with discrete perforation. A small bowel, jejunum, segmental resection was performed with enter-entero anastomosis More than 10 years ago, the patient underwent a right kidney transplant for an end-stage renal disease secondary to polycystic kidney disease, autosomal dominant. He has also benign essential hypertension and dyslipidemia. He is currently on immunosuppressive therapy with mycophenolic acid. From family history, the brother and the father have polycystic kidney disease.