The use of the emergency IV contrast-enhanced abdominal computed tomography (CT) scanning was evaluated in 90 pediatric patients sustaining blunt abdominal trauma. Medical records, CT scans, and operative and postmortem reports, when applicable, were reviewed retrospectively. By identifying the organs of injury, CT scans of the abdomen, with IV contrast, proved to be useful to the surgeon in deciding whether to operate in the setting of blunt abdominal trauma. The failure rate for conservative, non-operative management (four of 33) in "positive" scans was low, and represented progression of known injuries, not the appearance of unexpected injuries. Similarly, the (unplanned) surgery rate in the "negative" scan cases was low (one of 57). Abdominal CT scans cannot be relied on to consistently diagnose gastrointestinal perforation or pancreatic injury.