Fig. 2.

A 41-year-old gentleman diagnosed with traumatic brain injury-Subarachnoid hemorrhage with extradural hemorrhage right parietal lobe (a), APC type 2 pelvic injury (b), closed bilateral shaft of femur fracture (c,d) and closed both bone fracture right leg (e). On arrival, vitals were stable, GCS was E4, V4, and M5 (13/15), serum lactate was 4.6 mmol/L. He underwent external fixator application for pelvic injury (f), bilateral femur fractures (g,h), and tibia fracture (i) on day 1. On day 5, the patient became unstable with abdominal distension and was diagnosed with ileal perforation with closed-loop small bowel obstruction (j). Emergency laparotomy was performed with ileal resection and anastomosis. Subsequently, definitive fixation of both femur (k,l) and tibia fractures (m) were performed. The patient achieved a satisfactory outcome.