While all the injuries listed are potential problems in this patient, the most severe is blunt hollow viscus injury. A delay in diagnosis beyond 12 hours is associated with increased morbidity and mortality. There may be very few physical signs of a viscus perforation and CT findings may be subtle and not definitive. A seat belt sign across the abdomen should raise suspicion of this injury and prompt an aggressive pursuit of diagnosis by serial examination and a consideration of a peritoneal lavage or repeat CT scan.