CT scan not particularly sensitive for the diagnosis of a perforated viscus.
Exploratory laparotomy invasive, expensive and has risks of bleeding, infection and associated morbidity and mortality related to administration of a general anesthetic.
Complications, if massive and under tension, are decreased central venous pressure, decreased cardiac output, decreased mean arterial pressure and compression of the inferior vena cava.
If under tension can reduce tidal volume, displace the liver downward and leads to cardiovascular collapse.