•Penetrating trauma covers gunshot wounds and stab and puncture wounds.•Firearm related injuries make up the bulk of the mortality in penetrating trauma.•Nonoperative management acceptable in select patients.•CT is accurate in predicting the need for laparotomy in penetrating abdominal trauma.•Specific CT findings can indicate need for laparotomy or endovascular therapy. Penetrating abdominal trauma comprises a wide variety of injuries that will manifest themselves at imaging depending on the distinct mechanism of injury. The use of computed tomography (CT) for hemodynamically stable victims of penetrating torso trauma continues to increase in clinical practice allowing more patients to undergo initial selective non-surgical management. High diagnostic accuracy in this setting helps patients avoid unnecessary surgical intervention and ultimately reduce morbidity, mortality and associated medical costs. This review will present the evidence and the controversies surrounding the imaging of patients with penetrating abdominopelvic injuries. Available protocols, current MDCT technique controversies, organ-specific injuries, and key MDCT findings requiring intervention in patients with penetrating abdominal and pelvic trauma are presented. In the hemodynamically stable patient, the radiologist will play a key role in the triage of these patients to operative or nonoperative management.