Patients with the comorbid condition of connective tissue disease make operative management complex. Herein, we present the challenging case of a 23-year old man with Type IV Ehlers Danlos Syndrome who presented acutely with small bowel perforation. Both the small bowel perforation and enterotomies during surgery were successfully repaired by use of Polyglactin 910 (Vicryl) mesh pledgets rather when simple interrupted suture techniques proved to be ineffective secondary to poor structural integrity of the bowel secondary to Ehlers Danlos Syndrome. The sites of repair in subsequent operations were found to be intact, which shows that this method can be used in the repair of enterotomy in high risk patients with Type IV EDS.