Isolated involvement of rectosigmoid region is very rare. Such cases are difficult to diagnose clinically due to their nonspecific and atypical presentations. This may leads to misdiagnosis and sometimes unplanned treatment. A 65‑year‑old female had operated for suspected traumatic intestinal obstruction with operative findings suggestive of carcinoma rectosigmoid region. Later on, investigations had proved the case to be tuberculosis of that region without any other signs. Thus, a thorough knowledge of the various presentations of rectosigmoid tuberculosis is important in order to improve patient management.