Abdominal tuberculosis accounts for 11% of patients of extra-pulmonary tuberculosis. It is also the sixth most common form of extra-pulmonary tuberculosis. Abdominal tuberculosis that presents without pulmonary or general signs/symptoms of tuberculosis is rare events that occur only in 1.2% of the disease. It can result in an intestinal obstruction; however, it is a rare cause of intestinal obstruction that is usually overlooked or misdiagnosed. We report a 17-year-old female patient who’s not known to have any medical illness presented with acute abdominal pain due to small bowel obstruction with no significant effect on bowel habit. Imaging showed free fluid in the abdomen and small bowel obstruction. The patient was managed surgically with adhesiolysis and started anti-microbial therapy. The report describes the diagnostic challenges that abdominal tuberculosis can presents with, especially in patients without accompanying pulmonary or general tuberculosis signs/symptoms. Such a presentation can be a challenge to diagnosed and usually are mistaken with other differential diagnoses. Therefore, clinicians - especially in areas that are endemic with Tuberculosis - need to consider such rare diagnoses and have a high suspicion of tuberculosis in such a presentation.