Tuberculosis is a real public health problem. It is due to Mycobacterium tuberculosis, a bacterium with a strong pulmonary tropism. Extra-pulmonary forms represent 14% of all tuberculosis cases worldwide. Digestive damage represents 3% to 5%. The treatment of tuberculosis is well codified these days. A paradoxical reaction (PR) to anti-tuberculosis drugs is defined as worsening of pre-existing clinical or radiological lesions or the appearance of new lesions during anti-tuberculosis treatment. They are rarely described in the digestive system with an acute intestinal obstruction type. We report here a clinical case of a paradoxical reaction to the type of acute intestinal obstruction in an immunocompetent patient on anti-tuberculosis treatment. It was a 56-year-old male patient with no specific history, HIV-negative followed by pulmonology for bacteriologically confirmed pulmonary tuberculosis. He was put on Poly Chemotherapy (2ERHZ / 4RH). Progress under this treatment was marked by onset on day 35 of generalized abdominal pain associated with mechanical bowel obstruction with no fever. On admission to the surgical emergency room, besides abdominal pain, the patient presented bloating and bilious vomiting, abdominal meteorism and abdominal tympanism. The diagnosis of acute intestinal obstruction of the small intestine by obstruction of probable tuberculous etiology had been suggested and the patient operated on. During the operation, we had discovered dilated small intestine, multiple ileal and parieto-ileal adhesions with ileal strangulation 60 cm from the ileo-cecal junction, multiple granular micronodular lesions and mesenteric lymphadenopathy. Procudure included adhesions resection, biopsy of omentum and mesenteric lymphadenopathy The evolution was favorable and Histopathology analysis found images in favor of mycobacteriosis.