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However, 48\u00a0hr later, the patient developed signs of acute abdomen, prompting an exploratory laparotomy that uncovered 150\u2013180\u00a0cm of ischemic small bowel and pale, patchy lesions suggestive of vasculitis. Histopathology confirmed necrotizing vasculitis of small and medium vessels. This case illustrates how an incidental trauma led to the diagnosis of a silent but life-threatening systemic disease. The coexistence of vascular trauma and spontaneous ischemic bowel highlights the importance of considering systemic vasculitides in patients with unexplained abdominal findings, even when presenting with an unrelated surgical emergency.<\/jats:p>","DOI":"10.1093\/jscr\/rjaf496","type":"journal-article","created":{"date-parts":[[2025,7,11]],"date-time":"2025-07-11T23:34:37Z","timestamp":1752276877000},"source":"Crossref","is-referenced-by-count":0,"title":["When bullets unmask hidden fire: a rare case of undiagnosed small-vessel vasculitis revealed by dual surgical emergencies"],"prefix":"10.1093","volume":"2025","author":[{"ORCID":"https:\/\/orcid.org\/0009-0008-4177-6776","authenticated-orcid":false,"given":"Q","family":"Carlos D\u00edaz","sequence":"first","affiliation":[{"name":"Research Medical Department, Universidad Francisco Marroquin, Guatemala , Guatemala City 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