Schistosomiasis remains a major world health problem. The disease presents with protean manifestations in the endemic areas. Small bowel schistosomiasis leading to acute intestinal obstruction is an extremely rare clinical presentation. The disease may mimic peritoneal tuberculosis or carcinomatosis intra-operatively. Small bowel bilharziasis leading to obstruction has not been reported in the recent indexed English literature. This report describes a 50-year-old Yemeni male presenting with acute small bowel obstruction due to schistosomiasis. We review the pathological changes in the intestine following schistosomal infection and discuss diagnosis and treatment. We emphasize the importance of histopathology on all surgical specimens.