An unusual aspect of Pott’s disease: small bowel obstruction from a tuberculous psoas abscess

Pott's disease typically presents with back pain and systemic symptoms, but atypical presentations can obscure diagnosis. We describe a rare manifestation where the initial presentation was acute small bowel obstruction. A 20-year-old female presented with acute abdominal pain, distension, and vomiting, with a 3-month history of intermittent lower back pain. Computed tomography scan revealed distal ileal obstruction due to wall thickening adjacent to a left psoas abscess and a large paravertebral abscess. Aspirated pus confirmed <i>Mycobacterium tuberculosis</i>. The diagnosis was small bowel obstruction secondary to ileal thickening from an adjacent psoas and paravertebral abscesses. She was managed conservatively with abscess drainage and anti-tuberculous therapy. Intestinal obstruction is a rare presentation of spinal tuberculosis. In endemic areas, tuberculosis should be considered in the differential diagnosis of acute abdomen. Prompt imaging and microbiological confirmation, coupled with multidisciplinary management, are essential to achieve favorable outcomes.