The case was of a 23‐year‐old male international student from India who was urgently referred to the emergency department by his general practitioner for abdominal pain. He reported a 2‐day history of abdominal pain, distension and vomiting on a background of no past medical or surgical history. On examination, his abdomen was soft but distended. Computed tomography imaging demonstrated a distal small bowel obstruction (SBO) with a transition point in the right lower quadrant (Fig. 1a,b). He was commenced on intravenous fluids, a nasogastric tube was inserted for decompression and he was taken to the operating room for a diagnostic laparoscopy. At laparoscopy, serous fluid was suctioned from his pelvis and numerous nodules were scattered throughout the parietal and visceral surfaces of the peritoneum (Fig. 1c) with a band adhesion in the right lower quadrant that resulted in the acute obstruction (Fig. 1d). The differential diagnoses of an infective or malignant pathology were considered intraoperatively with cytological aspirate of the fluid ordered, and a partial omentectomy was performed for tissue to be sent for acid‐fast stains and histopathology. The patient made an uneventful recovery with resumption of gut function. The peritoneal fluid demonstrated no microbial growth nor malignant cells. Ziehl–Neelsen stain for acid‐fast bacilli was negative in the tissue sample. Using the recently endorsed World Health Organization recommended GeneXpert ULTRA Assay, which has been shown to have a significantly improved sensitivity over previous methods of cell culture, the rapid molecular detection of tuberculosis was confirmed. Tissue histopathology demonstrated granulomas in a pattern consistent with Mycobacterium infection (Fig. 1e,f). The patient was referred to the infectious disease service for ongoing management.