Spontaneous iliac vein rupture is an uncommon cause of retroperitoneal haematoma. Most common concomitant pathology reported was deep vein thrombosis or thrombophlebitis and followed by May-Thurner Syndrome. In this particular case, we observed findings parallel to literature. A 61-year-old female patient complaining of abdominal and back pain was admitted to the emergency room. She was a smoker and except that medical history revealed only chronic obstructive pulmonary disease. Also, she had no history of trauma. She suffered from sudden left abdominal and back pain without evident cause. On arrival, her vitals were normal. An abdominopelvic computed tomography (CT) showed large haematoma in the lower abdominal cavity. Retroperitoneal exploration revealed large haematoma and left external iliac vein rupture. The vein was repaired primarily. Postoperative follow-up visit at one month after surgery showed that the patient was doing well. Iliac vein rupture should be taken into account in middle-aged or elderly women with acute onset abdominal pain and acute DVT
