A 56-year-old man visited the hospital because of abdominal pain. Simple abdominal X-ray films revealed an intestinal obstruction, and a long tube was intubated for intestinal decompression. X-ray contrast examination of the small intestine demonstrated a rather smooth stenosis of about 7 cm in length in the ileum. Barium enema of the large bowel was normal. A tumor of the small intestine was suspected, because there was only a single focus. Operation was performed. After entering the peritoneal cavity, the ileum 90 cm proximal to the ileocecal valve was found to be involved by a partly whitish colored mass of hen's egg size. The regional lymph nodes were enlarged to little fingertip size on palpation. About 30 cm of the small intestine was resected together with the tumor and regional lymph nodes. The resected specimen had a thick intestinal wall and a deep ulcer perpendicular to the long axis of the intestine. Histological examination showed that the ulcer was U1 III. Langhans giant cells and caseating tubercules were seen in both the ulcer and the regional lymph nodes, so small intestinal tuberculosis was diagnosed histologically. Chest X-ray films were normal and the tuberculin reaction test was negative in this patient. There is a recent growing tendency to reveal no abnormal findings in a chest X-ray film in cases of intestinal tuberculosis.