Presentation of Case A 27-year-old man was admitted to the hospital because of trauma. He was well until 19 hours earlier, when he was involved in a motor-vehicle accident. He was taken to another hospital, where multiple injuries were found. Abdominal examination showed tenderness in the midepigastrium and left lower quadrant, without other abnormality. The systolic blood pressure fell to the range of 70 to 90 mm Hg and improved after fluids were administered by vein. The urine was normal. The hematocrit was 46 percent, and the white-cell count 19,800. The urea nitrogen was 13 mg per 100 ml.
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