Hemorrhagic Bowel Syndrome (HBS) is an acute, enteric disease, primarily of lactating dairy cows, with a high mortality rate and increasing prevalence. The objective of this case report is to describe the clinical signs, diagnostic tools, and treatments used to successfully treat one case of HBS in a 5-year-old mid-lactation Brown Swiss cow named 'Annie'. On presentation, Annie's vital parameters were within normal limits; however, she was hypokalemic and had a severe hypochloremic, metabolic alkalosis. Rectal palpation, abdominal ultrasound, and abdominocentesis all supported the diagnosis of intestinal obstruction, so a standing, right flank, exploratory laparotomy was performed. In surgery, an enterotomy was performed allowing removal of blood clots and feed material from the small intestine. Two days later, a palliative rumenotomy was performed to relieve a presumed ruminal impaction. After decompression, aggressive antibiotic, fluid, pain relief and prokinetic treatments continued. After 9 days in the hospital, Annie was discharged and four months later, continues to do well.