A Small bowel obstruction is a common condition that accounts for approximately 20% of all hospital admissions for abdominal pain [8]. The etiology of SBO is multifactorial, involving both intrinsic and extrinsic factors [9]. The principal intrinsic cause of SBO is intussusception, while the primary extrinsic causes are adhesions and hernias [9]. Intra-abdominal adhesions account for approximately 75% of SBO cases [9]. Adhesions occur as a consequence of previous surgery [9].

Constipation, nausea, vomiting, bloating, and abdominal pain are the most common symptoms in patients with SBO [6]. The abdominal pain is usually crampy, intermittent, and located in the central or lower abdomen [6]. Patients may also experience distension of the abdomen with an increase in girth and discomfort. SBO may be associated with a complete obstruction, leading to the absence of bowel movements, dehydration, and electrolyte imbalances [6]. The severity of the symptoms depends on the extent and duration of the obstruction, as well as the underlying cause [6].

While conservative management is often the first line of treatment, this approach is often insufficient as there is a high risk for SBO recurrence [10]. Conservative management for SBO includes bowel rest, fluid resuscitation, nasogastric tube placement for abdominal decompression, correcting electrolyte imbalance, and regular bowel monitoring [11]. Although recurrent SBO is more prevalent in the older population, it can also present in relatively young people [12]. It has been reported that recurrence rates in affected patients are approximately 20% [12]. The recurrence rate of SBO following surgery may be influenced by the type of adhesions present [13]. Specifically, the presence of diffuse adhesions appears to be associated with a greater likelihood of recurrence compared to the presence of single-band adhesions [13]. Lorentzen et al. demonstrated a recurrence rate of 12% among their study participants over 2.2 years of follow-up. They reported that multiple/matted adhesions (P = 0.046) and fascial dehiscence (P = 0.009) were associated with an increased risk of recurrence [14]. Patients who suffer from such instances are frequently afflicted with underlying conditions like adenocarcinoma [15]. These patients are more vulnerable to severe SBO, which can increase mortality [15].

SBO complications can be serious and even life-threatening if left untreated. One potential complication is bowel ischemia, which occurs when there is a lack of blood supply to the bowel, leading to tissue damage and potentially necrosis [8]. Additionally, SBO can lead to bowel perforation, which can cause peritonitis and sepsis [8]. In some cases, SBO may also lead to dehydration, electrolyte imbalances, and renal failure [8]. If left untreated, these complications can worsen and ultimately result in death. Therefore, promptly diagnosing and managing SBO is crucial to prevent these potential complications.

This case report describes a young male with a history of exploratory laparotomy following a gunshot wound, small bowel obstruction, and inguinal hernia repair. As stated above, patients with prior laparotomy are more likely to develop SBO, but the evidence of such recurrence in patients without comorbid conditions needs to be further examined [12]. Despite age and comorbid conditions, patients with a history of intra-abdominal operations or trauma should receive immediate diagnosis and surgical treatment if they present with symptoms of intestinal obstruction. Moreover, it is imperative that these patients are closely monitored and followed up in order to prevent recurrences and complications of SBO.

It is essential for clinicians to be aware of the possibility of rare presentations of SBO. This case will enrich clinical practice and management of SBO. It highlights the significance of prompt diagnosis and treatment, irrespective of a patient's age or medical history. This will lead to a better management of recurrent SBO in the future. We recommend exercising caution in patients with a history of previous SBO and monitoring them frequently in the outpatient clinic. Consequently, persistent SBO and its complications could be prevented or detected early. Prophylactic measures, such as early mobilization and the use of adhesion barriers, may reduce the incidence of postoperative adhesion-related SOB. Seprafilm, a type of adhesion barrier, has been shown to significantly lower the incidence of adhesive small-bowel obstruction requiring reoperation compared to no-treatment patients: 1.8 percent versus 3.4 percent (P < 0.05) [16]. This finding represents an absolute reduction in adhesive small-bowel obstruction requiring reoperation of 1.6 percent and a relative reduction of 47 percent [16]. A multidisciplinary approach involving close monitoring, early diagnosis, and individualized treatment plans is necessary for optimal SBO outcomes.