Peritoneal tuberculosis (TB) is one of the types of extrapulmonary TB that predominantly involves the omentum, liver, intestinal tract, spleen, or female genital tract. It can occasionally result in gynecological-related oncology diagnoses such as advanced ovarian cancer due to its non-specific signs and symptoms, making it very difficult to detect. This report presents a case of a 22-year-old female who presented with the chief complaints of pain and distension of the abdomen for one month with dysuria. Ultrasonography and magnetic resonance imaging was performed that reported a large uni-loculated cystic pelvic abdominal lesion likely to be of ovarian origin and suggestive of neoplastic etiology with bilateral hydroureteronephrosis. To confirm the diagnosis, an exploratory laparotomy was performed which revealed extrapulmonary abdominal TB, and was registered for Directly Observed Treatment Shortcourse (DOTS) following which anti-tubercular drugs were given. In conclusion, this case report highlighted the masquerading behavior of encysted peritoneal TB as an ovarian tumor, and the fact that it should, therefore, should be considered in the differential diagnosis in regions where TB remains endemic, such as in developing countries. Hence, an appropriate diagnosis can prevent the need for unnecessary surgical operations and adequate therapy can save the patient's life.