Objective – Bowel obstruction or perforation during pregnancy is a rare but life-threatening situation, and the management remains uncertain and patient dependant. We presented a case in our hospital with fever and acute abdomen in her second trimester, so we reviewed literatures and other cases to provide options for management based guidance to deal with this challenging situation. Case Report – A case at gestational age 19 weeks who was diagnosed with delayed presentation of Intestinal Perforation was referred to our centre from a primary health care centre without any history of previous surgery and was managed surgically with Emergency Laparotomy. The patients WIDAL came positive, that along with low socio economic background supported our diagnosis of Typhoid causing the Intestinal perforation. She had a challenging post operative period the foetus was expelled in view of sepsis one week after the surgery. We researched pubmed and reviewed 10 English literatures to form a a conclusions enlisting management options and how to deal with delayed presentation- Al lesson learnt. Conclusion – Our case presentation serves as a poignant reminder of the challenges faced by unusual presentations in acute abdomen during pregnancy. Timely intervention and a simultaneous cesarean section could be considered if the gestational age was large enough to avoid the comorbidities like maternal risk of sepsis that outweighs the risk of preterm birth.