The development of tuberculosis-related bowel obstruction or pseudo-obstruction during anti-tuberculosis therapy is rarely reported in immunocompetent patients. A 44-year-old male, who had neither HIV infection nor diabetes, was hospitalized because of pulmonary tuberculosis in November 2006. Three months after starting anti-tuberculosis therapy, he was admitted for suspected mechanical bowel obstruction. An emergency exploratory laparotomy showed distended bowel loops, and multiple skip lesions from the terminal ileum to the ascending colon. PCR analyses showed Mycobacterium tuberculosis. The therapy regimen was unchanged after the operation; the patient gradually improved over the course of a month and was discharged without further symptoms thereafter.