A 64-year-old male is admitted to the emergency department following a car accident. His pulse is 94 bpm, blood pressure 95/60 mm Hg, and HCT 30%. Severe hematuria is evident. Following resuscitation, his blood pressure is elevated to 120/80 mm Hg. A CT scan reveals extensive contusion confined to the left kidney and perirenal fat. His blood pressure declines to 80/40 mm Hg, and urgent laparotomy is performed via?

After entering the abdominal cavity the inferior mesenteric vein is isolated to the left of the fourth part of the duodenum and Treitz's suspensory ligament. An incision is made between the fourth part of the duodenum and the inferior mesenteric vein lateral to the aorta. This approach exposes the left renal hilum and allows early and accurate exposure and control of the left renal hilum. The approach allows exposure of the left kidney and enables the surgeon to determine if a renal repair or nephrectomy is needed. It also allows exposure to the opposite kidney.