Tuberculosis, a disease highly prevalent in developing countries, masquerades itself in various forms. Amidst the availability of treatment spearheaded by the government, there remains in the Philippines a great burden of morbidity and mortality from this illness. It most usually affects the lungs, but extrapulmonary forms also exist. This case focuses on a patient with abdominopelvic tuberculosis with a chief complaint of constipation, who presented on physical examination with vaginal synechiae, and was revealed on ultrasound to have hematopyotrachelometra. Initially, there was a dilemma in the diagnosis of the 79-year-old patient. Is the cause of the synechiae infectious or is it malignant? After which, comes the dilemma in the management. Is the hematometra best treated conservatively or surgically? The history, physical examination, diagnostics and course of this patient who was admitted twice for the same clinical presentation was explored in this case report.