At laparotomy, 2 L of blood was found in the abdominal cavity. There were multiple penetrating injuries to the small bowel and active bleeding from the right iliac bone and muscles of the pelvic and abdominal wall. The patient was unstable, hypothermic, and acidotic. Damage control measures were undertaken with rapid stapled resection of the small bowel (leaving the bowel ends stapled off), packing of the pelvis, and debridement of the wound on the patient’s back. The patient received 5 units of blood, 10 units of cryoprecipitate, and 3 units of fresh frozen plasma. He remained ventilated and was transferred to the ICU.

Two days later, at second-look laparotomy, there was no evidence of abdominal sepsis, and the bowel ends were anastomosed. An open fracture of the right iliac bone was evident with extensive muscle damage. The patient returned to the ICU.