Open AccessPrimary malignancies of the small bowel are rare and usually present with vague, non-specific symptoms. This leads to diagnostic difficulties for both physician and radiologists alike. We present a case of a 54-year-old lady with a virgin abdomen who initially presented to hospital with vague abdominal symptoms suggestive of gastroenteritis. She responded partially to conservative treatment but represented to hospital 3 weeks later with obstructive symptoms. Contrast CT was inconclusive with regards to diagnosis. A diagnostic laparoscopy was performed, revealing an infiltrative growth. Consequently, she underwent segmental laparoscopic-assisted small bowel resection and recovered well post-operatively. After further histological and endoscopic investigations, a final diagnosis of primary small bowel adenocarcinoma was given. As the prognosis of small bowel malignancy is stage-dependent, this case demonstrates a high index of suspicion is necessary to reach early diagnosis, especially for symptoms non-responsive to conventional treatment. Diagnostic laparoscopy should be considered early as a definitive diagnostic tool.