Acquired (non-Meckel's) ileal diverticular disease is uncommon, and most surgeons have limited, if any, experience with this condition. To gain insight into the frequency of surgical complications of ileal diverticula, we reviewed our experience during the past ten years with 21 patients, 12 women, and nine men. The mean patient age was 62 years; 16 patients (76%) were more than 50 years of age. Thirteen patients had associated diverticula in another segment of the small intestine. In 15 patients ileal diverticulosis was diagnosed during gastrointestinal (GI) radiologic evaluation of abdominal symptomatology. Ileal diverticula were identified intraoperatively in the remaining six patients. In three patients ileal diverticulosis was an incidental finding. Documented surgical complications of acquired ileal diverticula occurred in four patients (19%). Three patients had acute diverticular perforation, and one patient had diverticulitis without perforation. These patients underwent successful operative intervention. Three other patients, all managed nonoperatively, had abdominal symptoms that may have been related to ileal diverticula and were of potential surgical significance. Two patients experienced recurrent rectal bleeding, and the third patient had severe chronic abdominal pain. Although the majority of patients with acquired ileal diverticula do not require surgical treatment, complications such as perforation, bleeding, or incapacitating abdominal pain may necessitate ileal resection.