Seventy consecutive surviving patients with pelvic fractures were reviewed to define those at high risk for intra-abdominal injury. Eleven (16%) had serious associated visceral injuries. Initial hypotension, Malgaigne and bilateral pubic rami fractures, and blood requirements exceeding 2,000 cc were suggestive of abdominal trauma.These high-risk patients should undergo diagnostic peritoneal lavage as an integral part of their initial management. If the lavage is negative, continued hemorrhage should be evaluated with angiography and nonoperative means of vascular control attempted before resorting to laparotomy.