No wound is small: Delayed presentation of penetrating abdominal trauma by an iron nail

Penetrating abdominal injuries from seemingly trivial wounds may conceal significant intra-abdominal pathology and delayed complications. Early symptoms may be minimal, leading to underestimation of injury severity and delayed diagnosis. We present the case of a 29-year-old male who sustained a penetrating injury to the anterior abdominal wall from an iron nail following a fall at the workplace. The foreign body was removed at the scene, and the patient remained asymptomatic for one week. He subsequently developed abdominal pain accompanied by purulent wound discharge. Contrast-enhanced computed tomography revealed an abdominal wall defect with intraperitoneal communication, a pelvic collection, and signs of intestinal obstruction. Diagnostic laparoscopy, converted to exploratory laparotomy, revealed dense intra-abdominal adhesions, a purulent pelvic collection, and a sealed colonic perforation. Adhesiolysis and thorough peritoneal lavage were performed, and the patient had an uneventful recovery. No penetrating wound should be considered minor until proven otherwise. Even trivial-appearing nail injuries warrant careful evaluation, observation, and appropriate imaging to prevent delayed recognition of serious intra-abdominal complications.