A 44 year old lady presented with severe generalized abdominal pain since two days along with multiple episodes of non-projectile, non-bilious vomiting and diarrhea. She had been admitted in another institution for similar complaints twice in the past month. On both occasions, she was managed conservatively for gastroenteritis with bowel rest and antibiotics. She complained of abdominal pain during every menstruation since six months that reduced with oral analgesics. However, the intensity of pain would increase with every cycle and since two months; she also experienced associated diarrhea and tenesmus. She was not on any contraceptive pills. She had undergone a caesarean section ten years ago. She was otherwise stable, her abdomen was soft with diffuse tenderness and bowel sounds were present. Her abdominal radiograph showed small bowel obstruction with faecal loading in the ascending colon. Computed Tomography (CT) revealed a concentric infective/inflammatory thickening of the distal ileum with significant luminal narrowing of the ileocaecal junction and terminal short segment of ileum with proximal ileal dilatation. No complete mechanical obstruction was seen. Mild edematous thickening of the bowel loops with prominent vasa recta, mild surrounding fat stranding and inter bowel fluid (Fig. 1). The findings were suggestive of a subacute partial small bowel obstruction probably due to Crohn's disease. The colonoscopy showed a tight short ileal stricture just inside the ileocaecal junction. Balloon dilatation was attempted. The narrowing recurred as soon as the balloon was withdrawn, hence it failed (Fig. 2). The patient was managed conservatively but she continued to be symptomatic. Three days later, a colonoscopy was repeated and this time dilatation was done upto 15 mm. Submucosal hemorrhages were seen in the colon with ileocaecal ulceration. A differential diagnosis of tuberculosis was also considered. Despite the dilatation, her symptoms did not subside and the patient was taken for a diagnostic laparoscopy. Intraoperatively, a distal ileal stricture with multiple enlarged lymph nodes were seen. A lump was seen at the tip of the appendix, however the base appeared normal (Fig. 3). No other abnormality was found. A laparoscopic right hemicolectomy was done. Postoperatively, the patient recuperated well and was gradually put on diet. The specimen grossly showed a dilated ileal segment, with the stricture being 2.5 cm in length. Pathologically, the ileum showed multiple endometritic foci with fibroblastic proliferation with a secondary stricture. The Appendix also showed multiple endometriotic foci. The immunohistochemistry (IHC) studies showed the glands to be positive for estrogen, progesterone receptors and vimentin. The stroma was positive for CD10 and vimentin. This confirmed the endometrial origin. No mucosal involvement was seen (Fig. 4). However, the caecum and ascending colon were free from endometriosis. Thirty lymph nodes were resected, all of which showed reactive inflammatory changes. The patient was discharged after a week on full diet. She is on regular follow-up with no cyclical complaints and is not on any hormonal therapy.