Bleeding into the peritoneum
Guarding and tenderness, as well of other signs of abdominal inflammation, might be expected in the presence of intraperitoneal bleeding, though in the acute situation, such signs may not have had time to develop.
To exclude intraperitoneal bleeding a peritoneal lavage should be performed. Ultrasound is also increasingly used.
If positive an emergency laparotomy should be performed.
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