Acute abdomen in Kawasaki disease (KD) has been reported to occur in 1.4 to 4.6% of cases. Around 2 to 3% of patients with KD present with features of intestinal pseudo-obstruction. Vasulitis of the mesenteric artery with consequent ischaemia of the gut and dysfunction of the myenteric plexus has been linked to the pathogenesis of intestinal pseudo-obstruction in KD. The treatment of the acute abdomen in KD, whether conservative or surgical, is a matter of debate. However review of the available literature showed more consensuses towards conservative management with intravenous immunoglobulin (IVIg) and gut rest. We describe the case of a five months old male infant who presented with high fever, vomiting and prominent abdominal distension. He was ultimately diagnosed as a case of KD with intestinal pseudo-obstruction and successfully managed with conservative treatment.