| Summary: | We report two rare cases of spontaneous left iliac vein rupture associated with May-Thurner syndrome. A 60-year-old patient presented with acute lower abdominal pain and was diagnosed with a retroperitoneal hematoma and left iliac vein thrombosis. She was managed conservatively with anticoagulation and inferior vena cava (IVC) filter placement, resulting in complete thrombus resolution within 2 months. A second patient, aged 65 years, presented in hemorrhagic shock with extensive deep vein thrombosis of the left lower limb. After resuscitation and transfusion, she underwent IVC filter placement and anticoagulation, with full thrombus resolution confirmed at the 3-month follow-up. These cases highlight the diagnostic challenges of spontaneous iliac vein rupture and the importance of early recognition. Conservative management with anticoagulation and IVC filter placement may be a safe and effective alternative to surgery in stable patients.
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