In Britain abdominal tuberculosis is an uncommon condition and most cases come to laparotomy for diagnosis. A high index of suspicion is required in areas with a large immigrant population and in areas which are overcrowded and nutritionally deprived. Nine of 28 patients presented acutely and a wide variety of preoperative diagnoses were entertained. Most of the remainder had a long history of vague constitutional symptoms and laparotomy was required for diagnosis in all but 5. Histology proved the surest way of establishing the diagnosis.