We report a rare case of a spontaneous rupture of the iliac vein which was then surgically treated with good results. A 66-year-old woman was admitted complaining of leg swelling and lower abdominal pain. On the 3rd day after admission, an operation was performed because of a gradually increasing hematoma in the retroperitoneal space. Laparotomy revealed a 17 mm longitudinal tear on the anterior surface of the left external iliac vein with a thrombus inside the lumen. Most of the previously reported 14 cases of this nature have required emergency operations.

The presence of a horseshoe kidney associated with aortoiliac vascular disease poses technical difficulties in terms of vascular reconstruction. The renal isthmus, position of the renal pelvis and ureters, and variable blood supply to the horseshoe kidney can complicate aortoiliac reconstruction. The left retroperitoneal approach provides excellent exposure of the abdominal aorta in patients with a horseshoe kidney without dividing the renal isthmus and avoids the risk of injury to a ureter in an anomalous position. We herein report the case of a patient with a horseshoe kidney who underwent a successful reconstruction of aortoiliac vascular disease using the left retroperitoneal approach.

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A 69-year-old male, who had retended for more than 33 years due to injury of the lumbar spine, complained of dyspnea and was diagnosed as tension pneumothorax associated with giant bulla. Eight years before, the patient had undergone thoracic drainage for 2 weeks under a diagnosis of spontaneous pneumothorax at a near practitioner. A giant bulla, which was found on a chest X-ray film and chest CT, was occupying the entire left lung field on admission. Thoracic drainage was started immediately after admission, but failed to relieve dyspnea. Further inserting a drain into the bulla could provide symptomatic remission, but could not dilate the affected lung. According to Naclerio-Langer method, surgical treatments including resection of bulla were performed. Excepting bedsore, postoperative course was uneventful. Arterial blood gas analysis revealed that PaO2 and PaCO2 were improved to 60 mmHg and 43 from preoperative 52 and 37, respectively. The patient was discharged on 40th day after surgery.

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