The decision to perform a trauma laparotomy is made taking into account the mechanism of injury; physical examination, imaging, and laboratorial tests; and local hospital resources. Early diagnosis and timely surgical repair are the key determinants to the outcome of the patient.

Blunt trauma can damage abdominal structures by compression (secondary to a direct blow or against a fixed external object by the seat belt) or from deceleration forces. The liver and spleen are the most frequently damaged organs. New highquality helical CT scans with multislice reconstructions have increased the identification of injuries and selection of patients to nonoperative treatment. CT of the abdomen is commonly used but has limitations, especially in excluding hollow viscus injury in the presence of solid organ injury.

In patients with blunt trauma, the initial abdominal physical examination is often unreliable, and as many 40 % of patients with hemoperitoneum have no findings in the initial evaluation. Seat belt sign from motor vehicle crashes is associated with intra-abdominal injuries in nearly 50 % of patients with a higher prevalence of small bowel trauma. Associated extra-abdominal injuries and the effect of altered level of consciousness as a result of neurologic injury, alcohol or drugs, are another major confounding factors in assessing blunt abdominal trauma.