Acute surgical abdomen is a diagnostic and therapeutic emergency, manifested by a generalized contracture of the abdominal muscles following a peritoneal irritation. In the majority of cases, acute peritonitis is the most common etiology requiring urgent surgical intervention. Nevertheless, some medical pathologies, notably acute adrenal deficiency and inflammatory colitis, can mimic this surgical situation, leading to an aberrant surgical intervention. Through a clinical case, we report the diagnostic and therapeutic modalities of a multifocal tuberculosis initially admitted for an acute surgical abdomen.