We present a case of a 37-year-old male who came to Yanet internal medicine speciality centre, Hawassa, Sidama,Ethiopia. He presented with intermittent crampy abdominal pain of 3 months duration. He complained of occasional abdominal distension and intermittent vomiting of ingested matter occasionally with bilious content. He had constipation but had no failure to pass faeces or flatus. In addition, he had easy fatigability, loss of appetite and unquantified significant weight loss. The patient reported that he had the above symptoms for the last 3 years but the symptoms have worsened in the last 3 months prior to his current presentation.
He had no diarrhea or cough.
His past medical history is unremarkable.
On physical examination, he looked acutely sick.
On V/S (Vital Sign) PR (Pulse rate)-104 bpm RR (Respiratory rate)-20 bpm T (Temperature)-ATT (Afebrile to touch) BP (Blood pressure)-100/70 mmHg.
On HEENT- he had slightly pale conjunctiva.
On abdominal examination- the abdomen looked soft, which moved with respiration; there was no visible peristalsis, no area of tenderness, and DRE (Digital rectal examination)-normal.
On investigation.
Hemoglobin (Hgb)=8.4 g/dl Hematocrit (HCT)-27.9.
Platelet (Plt)= 295x103/uL
Complete blood count (CBC)- White blood cell count (WBC)=6.5x103/uL Granulocyte=73% Lymphocyte=15%. 
Blood group and Rh= o+.
FBS (Fasting blood sugar), BUN (Blood urea nitrogen), Creatinine, ALP, AST, ALT are all normal.
Serum Na, K+, Cl- were in the normal limits.
On imaging.
CXR (Chest x ray) was normal.
Abdominal Ultrasound - There was a short segment of small bowel mass like asymmetric wall thickening measuring 4.5cm by 2.2 cm over the LUQ (Left upper quadrant) with a maximum wall thickness of 1.2cm. There were multiple adjacent mesenteric lymphadenopathies, the largest 1.1cm. The proximal small bowel was distended up to 5cm with collapsed distal bowel. The conclusion was, short segment small bowel wall thickening with luminal stenosis and features of partial SBO (Small bowel obstruction) and mesenteric lymphadenopathies, and small bowel carcinoma was considered as differential diagnosis, and Abdominal CT (Computed tomography) was recommended.
On Abdominal CT there were multi-focal short and long segment symmetric wall thickening of small bowel loops, which was marked in the left lower quadrant narrowing the lumen with proximal bowel loops dilatation and shouldering. There were also multi-focal luminal narrowing (constrictions) of the involved small bowel loops with associated focal wall thickening. Small mesenteric lymph nodes were noted in the left lower quadrant small bowel mesentery with adjacent mesenteric fat stranding and internal hypoattenuation in keeping with central necrosis (see Figure 1). 
The patient was admitted with the consideration of Inflammatory bowel disease (IBD) and was given IV Ceftriaxone and Hydrocortisone and kept on maintenance fluid for 36hrs. After Small bowel Carcinoma was entertained, he was transferred to the surgical side. Because of a blood shortage, he was transfused with only 1 unit of X-matched blood and taken to OR (Operation room) for exploratory laparotomy. Under GA (General anesthesia) and ETT (Endotracheal tube) abdomen was cleaned and draped, then entered through a vertical midline incision, there was a distended small bowel about 200cms away from the ligamentum trietz, and the distended segment was about 100cm long, and there were three constrictions nearly obstructing the lumen which were a few centimeters apart. There were scant shooty mesenteric lymph nodes, there was no fat stranding, and the rest of the bowel looked normal. So we did segmental resection and end-to-end ileo-ileal anastomosis (See Figures 2 and 3). The site of anastomosis was about 100cm proximal to the ileocecal junction. After thorough lavage, the wound closed in layers, and the count was correct. The patient had a smooth postoperative course and was discharged on the third postoperative day. He returned to the outpatient clinic after 2 weeks with the pathology result. The microscopic description of the Pathology report stated: Sections from the intestinal lesions and mesenteric lymph nodes revealed nodular aggregates of epitheloid cells surrounded by mixed inflammatory cells and scattered Langhans type giant cells with areas of central caseous necrosis. That was histomorphologically consistent with Tuberculosis (See Figures 4-9). He was doing well and started on anti TB medication. He came to follow-up at two and seven months postoperatively and he was doing fine with all the symptoms resolved.