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A man in the 30s presented with acute abdominal pain, nausea and fever, 1 year after sustaining blunt abdominal trauma. He had no history of prior abdominal surgery. Imaging revealed bowel distension and free fluid without an identifiable obstruction point. Exploratory laparotomy uncovered multiple post-traumatic adhesions, ileal stenosis and punctiform perforations, requiring resection and anastomosis. The patient recovered uneventfully. This case underscores the importance of maintaining clinical suspicion for post-traumatic adhesions as a rare but serious cause of small bowel obstruction. Delayed symptom onset and inconclusive imaging can obscure diagnosis. Early surgical intervention is critical for preventing complications such as ischaemia or perforation. Clinicians should consider trauma-related adhesions in patients with a ‘virgin abdomen’ presenting with obstructive symptoms.