Spontaneous rupture of the iliac vein presenting with hemorrhagic shock and extensive venous thrombosis.

We report the case of a 48-year-old woman admitted with acute right flank pain and circulatory collapse. The initial diagnosis was right iliac vein thrombosis and a large retroperitoneal hematoma. Emergency surgery at a local hospital evacuated the hematoma and repaired the right external iliac vein. Postoperatively, she developed severe right leg swelling and pain, and limb-threatening ischemia with extensive right lower limb deep vein thrombosis. After transfer to our center, she underwent inferior vena cava filter placement and emergency thrombectomy. Our initial experience in approaching patients with deep vein thrombosis, abdominal pain, and shock considers spontaneous iliac vein rupture for timely intervention.