This case highlights the importance of considering endometriosis as a cause of small bowel obstruction in a young female without a surgical history. In this case, the patient had a diagnostic laparoscopy after the 2nd small bowel obstruction which detected endometriosis, and follow-up MRI and CT prior to definitive surgery for small bowel resection. The intraoperative photos illustrate just how extensive and fibrotic endometriosis can be, with areas of tethering and narrowing of the small bowel corresponding to the abnormal appearance on the last CT.