A 66-year-old man, who was a passenger in a car involved in a low-speed head-on motor vehicle accident, was rushed to our hospital. His abdomen was tender and distended. An enhanced computed tomography scan showed a massive retroperitoneal hematoma, and its three-dimensional imaging revealed an active leak of the contrast medium from the aortic bifurcation. He went into shock, and was immediately transferred to the operating theater. Through a median laparotomy, a ruptured site measuring 5 mm in diameter was found at the aortic bifurcation and it was closed with sutures under a proximal aortic control. The other organs showed no evidence of injury. Because of the remarkable edema of the bowel, mesentery, and retroperitoneum, the abdomen was temporarily closed with a mesh sheet to prevent the occurrence of abdominal compartment syndrome. A delayed closure was then successfully performed 4 days later, and he was discharged with no residual sequelae 17 days after the initial operation.
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