An 11-year-old girl had fallen off a horse and had been hit by the horse’s hoof. The paramedics found her complaining of abdominal pain and with a tense abdominal wall. She was transferred to our hospital’s trauma room. Here an interdisciplinary team of pediatricians, anesthesiologists, trauma and abdominal surgeons as well as radiologists examined the young patient according to standardized algorithms, based on the ATLS (advanced trauma life support) guidelines. An early abdominal ultrasound revealed free abdominal fluid especially in the Koller’s and Morrison’s pouch. This led to the decision to conduct a thoraco-abdominal contrast- enhanced trauma CT.