Enteropathy-associated T-cell lymphoma (EATL) is a rare and highly aggressive subtype of non-Hodgkin's lymphoma, strongly associated with celiac disease, that often presents with intestinal obstruction or perforation. In a 69-year-old woman, the initial presentation was gastroduodenal perforation with acute peritonitis. Two months later, small bowel perforation occurred, requiring urgent partial resection with jejunojejunostomy. Histopathological examination confirmed the diagnosis of EATL. In addition, secondary bone involvement was detected, which is a rare finding in this disease. The case shows a life-threatening gastrointestinal perforation requiring surgical intervention. A high index of suspicion, repeat biopsies, and multidisciplinary collaboration are key to diagnosis and management. The pathogenesis of EATL remains unclear and standardized treatment protocols are lacking.