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A 60-year-old female with no previous medical history presented to our level I trauma center as a restrained passenger following a motor vehicle crash, complaining of abdominal pain. On primary survey, she was hypotensive with a blood pressure of 63/39 with an abdominal seat belt sign on exposure. She started receiving blood products and had a positive focused assessment with sonography in trauma in the upper abdominal quadrants. She was taken emergently for an exploratory laparotomy after not responding to resuscitation.