Purpose <p>Penetrating anal injuries resulting from falls from height are a rare form of high-energy trauma, often accompanied by multiple organ injuries and delayed complications; giant bladder stones caused by retained wooden foreign bodies are particularly rare and highly prone to misdiagnosis. This study reports a case of this rare condition and highlights the key factors for achieving the best possible outcome.</p> Methods <p>This study presents the case of a 14-year-old male patient who sustained multiple penetrating anal injuries caused by a wooden foreign body following a fall from a height. Abdominal CT was used to assess the location of the foreign body and the extent of organ injury; the patient underwent emergency open abdominal surgery and transcatheter arterial embolisation for haemostasis, followed by long-term follow-up involving further imaging and interventional procedures as new symptoms arose.</p> Results <p>Initial abdominal CT revealed a foreign body in the abdomen and pelvis, accompanied by ileal and bladder injuries. Gross hematuria was present at admission, and urinary catheterization was maintained for 14 days postoperatively. The patient was discharged on postoperative day 20. Following emergency surgery and embolisation, the patient was discharged on the 20th postoperative day. Eight and a half years later, the patient developed lower urinary tract symptoms; a urinary tract CT scan revealed a giant bladder stone surrounding the residual foreign body, and the patient made a full recovery following surgical removal.</p> Conclusion <p>For such patients, early and accurate diagnosis, prompt emergency surgery, thorough intraoperative exploration, objective assessment of bladder healing, and continuous long-term follow-up are crucial for preventing late complications and achieving the best possible outcomes.</p>