Tuberculosis (TB) is a multi-organ disease. The most common manifestation is a pulmonary disease, but involvement of the gastrointestinal tract is not uncommon with the ileocaecal region being the commonest site. But ileal perforation due to tuberculosis is a rare manifestation. Here, we report a case of ileal tuberculosis presenting as perforated viscus while on treatment for genitourinary tuberculosis. Though, perforation of ileal tuberculosis is rare, it should be considered as a possibility when patients present with features of perforated viscus, particularly in patients who are diagnosed or suspected of tuberculosis.