Purpose Renal transplants are predominantly placed extra-peritoneally, thereby avoiding introduction of new structures intra-peritoneally which may precipitate future bowel obstructions. Disruptions to normal intra-peritoneal anatomy by graft ureter, in simultaneous pancreatic-kidney (SPK) transplantation or intraperitoneal kidney transplant can be a elusive precipitant for bowel obstructions. We aim to increase awareness for reviewing surgeons on a uncommon yet easily overlooked cause for bowel obstructions. Method Two patients from separate institutions, one with large bowel obstruction related to SPK transplant and one with small bowel obstruction due to transplant ureteric anastomoses from a renal transplant was described. Results Patient 1 underwent SPK transplantation with intra-peritoneal anastomoses of transplanted ureter to bladder. She presented with grossly distended abdomen and large bowel obstruction was diagnosed. Laparotomy revealed ischaemic colon angulated over the transplanted ureter as the transition point at rectosigmoid junction. Patient 2 underwent right renal transplant with graft ureter anastomosed to previously created ileal conduit fashioned for congenital hypoplastic kidney. Small bowel obstruction ensued with a transition point on the intra-peritoneal graft ureter and ileal-conduit. In both cases, careful identification of anatomical structures was critical as inadvertent damage to the graft ureter, mistaken for a band adhesion, is possible. Conclusion Careful consideration must be given to obstructed patients with intra-peritoneal kidney transplants, as the intra-peritoneal ureter can often be the transitioning point for obstruction and be inadvertently damaged if mistaken for band adhesion.