Small bowel obstruction is a common surgical problem with many potential etiologies. A 24-year-old African-American male presented with bowel obstruction secondary to incarcerated inguinal hernia and mesenteric fibromatosis. The latter diagnosis was delayed. Surgical correction of both etiologies was required. Our case represents an interesting combination of one of the most common causes and certainly one of the least common causes of bowel obstruction occurring simultaneously. Overall, mesenteric fibromatosis is a rare condition with an incidence of about 2-4 patients per million. It is, however, the most common primary mesenteric tumor. This case represents a rare and potentially unique simultaneous occurrence of both the most common as well as one of the least common causes of bowel obstruction.