Amyloidosis may uncommonly present with intestinal pseudo-obstruction. Previous reports have described an acute presentation with AA amyloid and a more chronic syndrome with AL amyloid. We report the case of a 78-yr-old man who presented with clinical and radiographic features of an acute small bowel obstruction and who, at laparotomy, was found to have intestinal pseudo-obstruction due to AL amyloidosis. We believe this case represents the first report of acute pseudo-obstruction from AL amyloidosis; awareness of this presentation may facilitate earlier diagnosis.