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The findings on physical examination of the abdomen combined with the seatbelt markings and free fluid on the CT scan all point to the presence of a ruptured hollow viscus. Non-operative management is not an option due to the presence of abdominal tenderness and guarding due to peritonitis. |
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Laparoscopy will miss a significant percentage of bowel injuries, even if the whole small bowel is run, and does not allow evaluation of the duodenum or retroperitoneal colon.
At laparotomy the patient had a blow-out injury of his ileum requiring resection and primary anastomosis.