Introduction: Actinomycosis is an uncommon diagnosis, involving the abdominal cavity in around 20% of cases. It is characterized by its tendency to form masses and abscesses that, added to its subacute onset, can be difficult to differentiate from other conditions. Obstruction is rare but is mainly associated with the presence of an abnormal growth of tissue as mimicking a malignancy. Pelvic forms are usually related to prolonged use of intrauterine devices, although other causes within mucosal disruption have been described. Case report: A 36-year-old woman with type 1 diabetes mellitus and diabetic nephropathy who underwent pancreas-kidney transplantation, with no incidences during the surgical procedure. She developed fever, which did not disappear despite drainage of abdominal fluid collections. Subsequently, she developed abdominal obstructive symptoms requiring urgent surgery. During the exploratory laparotomy, numerous small white formations were identified scattered throughout the entire abdominal cavity, causing firm adhesions between bowels. During the procedure, biopsies were taken and adhesiolysis was performed. Conclusion: Abdominal actinomycosis must be considered not just in the presence of fever and weight loss but also must be rule out in unusual onsets such as small bowel obstruction. To our knowledge this presentation as disseminated lesions has not been described in the literature.