With a thoracic and abdominal injury there must be a diaphragmatic laceration. Although the natural history of diaphragmatic injury is not fully clarified most surgeons would fix diaphragmatic injuries greater than once centimetre in length. Assessment and repair can be performed at laparotomy, or increasingly using laparoscopic techniques.

She is haemodynamically normal and does not require this as an emergency procedure. The splenic injury can be managed non-operatively and she should be nursed in a high dependency area with frequent haemodynamic observations and abdominal examination.