Small bowel tumors and Crohn’s disease are common causes of small bowel obstruction.Early stage neoplasms can easily be mistaken for Crohn’s disease.Therefore,thorough work-ups including imaging studies and endoscopic evaluation with biopsies are critical for accurate diagnosis.Here we report a case of an otherwise healthy female with progressive onset of multiple,recurrent obstructive symptoms secondary to terminal ileal narrowing who was referred for management of steroid-dependent Crohn’s disease.After thorough evaluation,the diagnosis was revised to myeloid granulocytic sarcoma involving the terminal ileum.In this case,a delay in diagnosis can be detrimental for prognosis,as myeloid granulocytic sarcoma is highly predictive of underlying acute myeloid leukemia and needs urgent referral for chemotherapy and/or resection. Small bowel tumors and Crohn’s disease are common causes of small bowel obstruction. Early stage neoplasms can easily be mistaken for Crohn’s disease. Beforefore, thorough work-ups including imaging studies and endoscopic evaluation with biopsies are critical for accurate diagnosis. Here we report a case of an otherwise healthy female with progressive onset of multiple, recurrent obstructive symptoms secondary to terminal ileal narrowing who was referred for management of steroid-dependent Crohn’s disease. After thorough evaluation, the diagnosis was revised to myeloid granulocytic sarcoma involving the terminal ileum. this case, a delay in diagnosis can be detrimental for prognosis, as myeloid granulocytic sarcoma is highly predictive of underlying acute myeloid leukemia and needs urgent referral for chemotherapy and / or resection.