An important consideration in small intestine resection is the length of residual bowel – less than 200cm length carries a risk of intestinal failure commonly termed short bowel syndrome. It is particularly pertinent in emergency surgical resections where there is already an underlying malabsorptive condition, and remains at the forefront of surgical decision-making. This presentation discusses a case of acute intestinal perforation due to advanced enteropathy-associated T-cell lymphoma (EATL) in a patient with celiac disease. We focus in particular on bowel length preservation techniques employed at time of surgery, the rare underlying aetiology and discuss the management of intestinal failure in anticipation of chemotherapy. Although a rare pathology accounting for less than 1% of Non-Hodgkin lymphomas and largely documented through case series, EATL remains an important consideration, largely due to best practice aimed at avoiding and preventing resection altogether. In cases of EATL presenting with perforated peritonitis, it is important to consider the ramifications and interplay between emergency resection prior to commencing definitive treatment. This case is presented in context to illustrate the role of conservative resection aiming to minimise recovery time and complications and expedite time to definitive systemic treatment. We conclude that awareness of rare pathologies, where surgical intervention is acutely life-preserving, can guide clinical decision-making in the patient’s best interests.