Following a car crash, what is the most appropriate action for a patient with mild abdominal tenderness and free air on abdominal films?

The most appropriate action for a patient with mild abdominal tenderness and free air on abdominal films is to prompt celiotomy. In the context of trauma, the presence of free air in the abdomen often indicates a perforation or significant injury to the gastrointestinal tract. Even if the abdominal tenderness is mild, the presence of free air suggests that there is a risk of intra-abdominal injury that could potentially lead to complications such as peritonitis or sepsis if not addressed swiftly.

Celiotomy allows for direct visualization of intra-abdominal structures, enabling the identification and repair of any perforations, and the assessment of other potential injuries. This step is critical in managing trauma patients, particularly when free air indicates a possible breach in the integrity of the gastrointestinal system. Prompt surgical intervention can significantly impact patient outcomes by preventing further complications.

Other options, such as peritoneal lavage, may help assess for intra-abdominal bleeding but are not definitive management strategies when there are signs of perforation. A contrast x-ray, while useful in some scenarios, is generally not the first-line investigation when there is already evident free air, as it can delay necessary surgical intervention. Careful observation may have a role in certain cases where there is a strong suspicion for minor injuries; however