A 72-year-old man with hypertension and a 40 pack-year smoking history presents with sudden severe left flank pain radiating to the groin that began one hour ago; he has never experienced similar pain before. He briefly lost consciousness at the onset. On examination he is pale and sweaty with a pulse of 108/min and blood pressure 102/68 mmHg; the abdomen is obese and mildly tender centrally. Urinalysis shows 2+ blood. Which one of the following is the most likely diagnosis?
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