Highlights Diagnosis of abdominal tuberculosis is challenging due to non-specific findings and clinical signs. A high index of suspicion of abdominal tuberculosis should be kept especially in endemic areas and for immune compromised patients who present with non-specific abdominal symptoms. Abdominal tuberculosis rarely presents as umbilical hernias with only 1 reported case in the literature. Routine histopathologic examination of hernial sacs should be considered in high endemic areas of abdominal tuberculosis.