Abstract
We report a 37-year-old male patient who had nonbilious vomiting, no passage of flatus, and recurring abdominal pain. This patient had de novo intestinal myeloid sarcoma (MS), a rare and chameleonic presentation of acute leukemia of myeloid origin. The initial diagnostic evaluation suggested Koch's abdomen, and surgical excision of the bowel was performed with a clinical suspicion of Koch's or lymphoma. However, following extensive evaluation, it was diagnosed as chloroma. The rarity of intestinal MS without a pre-existing hematolymphoid malignancy presents a substantial diagnostic challenge, as few cases are documented in the literature.