Multiple Small-Bowel Perforations Following a Stab Wound and Challenges in Managing a High-Risk Trauma Patient: A Case Report

Abstract

Penetrating abdominal trauma carries significant morbidity, and the occurrence of multiple small-bowel perforations is particularly uncommon. We report the case of a 28-year-old male who presented with anterior abdominal evisceration of small bowel and mesentery following a knife assault. He arrived in class III hypovolemic shock and underwent an emergency laparotomy. Five distinct small-bowel perforations were identified and managed successfully which is very rare. His initial postoperative recovery was uneventful, and ileostomy reversal was performed four months later. The reversal was complicated by a localized anastomotic leak, which was managed conservatively with complete resolution. This case highlights that even multiple small-bowel perforations resulting from penetrating trauma can be effectively managed with timely resuscitation, appropriate surgical repair, and staged reconstruction, leading to a favourable outcome.