A 54-year-old Sudanese man presented with persistent non-bile-stained projectile vomiting and epigastric pain for 2 years associated with marked loss of weight. He had no jaundice, fever or change in bowel habits. He did not have a cough or hemoptysis and his other systems were unremarkable. He had no significant past medical history, no history of TB, HIV infection or diabetes, he was not hypertensive, and there was no family history of a similar condition or TB. He was on antacid medicine; he was not a tobacco smoker and neither was he an alcoholic. A physical examination showed a body mass index (BMI) of 18, normal vital signs, he was not pale or jaundiced, there was no cervical lymphadenopathy and his chest examination was clear. His abdomen was flat, moved with respiration, with no dilated veins, surgical scars or cautery marks and hernia orifices were intact. There was no tenderness, masses, organomegaly or ascites; his succussion splash was positive. The results of hematological tests were normal, his erythrocyte sedimentation rate (ESR) was 30 mm/hour, and hepatitis B, C and HIV were negative. An upper GI endoscopy showed that his stomach was full of fluid and food particles and an ulcerated pyloric mass extended to the proximal part of his duodenum with severe narrowing. Multiple biopsies were taken and histopathology revealed gastric mucosa heavily infiltrated by florid active inflammatory cells disrupting the glands, which consisted of neutrophils, lymphocytes and plasma cells. The glands exhibited cryptitis and regenerative changes with the presence of multiple lymphoid follicles. No Helicobacterpylori, dysplasia or evidence of malignancy was seen. A sonographic test showed a 4.4×2.5 cm hypodense focal soft tissue mass in his pyloric region with enlarged para-aortic and mesenteric lymph nodes, there was minimal pelvic ascites, normal liver and other organs. A computed tomography scan of his abdomen and pelvis showed nodular hypodense lesions measuring 30 mm surrounding the antrum of his stomach with gastric dilatation and multiple mesenteric lymphadenopathies measuring 40 mm. Peritoneal thickening and ascites were also noted, otherwise, he had a normal liver, spleen, pancreas, kidneys, pelvic organs as well as aorta and inferior vena cava (IVC; Figs. and ), and a normal chest X-ray. A decision was made to relieve the obstruction. Intraoperative findings were: dilated stomach and 8×7 cm mass at the gastric pylorus with multiple mesenteric lymph nodes, and peritoneal and omental seedlings all over with small nodules on the surface of the liver; a gastrojejunostomy was done with multiple biopsies from the mass and the lymph nodes which showed caseating material during dissection. The result of histopathology confirmed the diagnosis of abdominal TB. The patient’s postoperative course was uneventful and he started feeding on day four; he was discharged in good condition. Moreover, he was on serial follow up which showed that he gained weight of more than 1 kg over 20 days. He was referred to the TB eradication program for antituberculous therapy and screening for pulmonary TB which was negative (acid-fast bacilli, AAFB).