Tuberculous bowel perforation is a rare yet severe complication of tuberculosis. Tuberculous lesions most commonly localize in the ileocecal region, leading to ulcers, mucosal hypertrophy, strictures, and intestinal perforation in extreme cases. This article presents a case of a 46-year-old patient admitted with abdominal pain, nausea, vomiting, and cessation of flatus and bowel movements. Computed tomography raised a suspicion of prepyloric perforation. Laparotomy revealed ileal perforation, approximately 15 cm proximal to the ileocecal valve. The affected bowel segment was resected, and a two-layer side-to-side anastomosis was performed. Despite effective surgical treatment and intensive postoperative care, the patient died on postoperative day 9. Autopsy revealed advanced caseating granulomas of tuberculosis.