Introduction: In reporting this case of a patient with spontaneous iliac vein rupture, we highlight the importance of maintaining a high clinical suspicion of this vascular emergency in the at-risk patient. Case Report: A 50-year-old female with an uncommon language barrier presented with left lower abdominal pain after falling. Initial imaging showed pelvic hematoma of unclear etiology. Repeat computed tomography showed expanding hematoma, and after hemodynamic decompensation, exploratory laparotomy revealed a ruptured iliac vein. Conclusion: Although rare, spontaneous iliac vein rupture has a high mortality rate, even when identified early. This case serves as a reminder to consider this potentially fatal diagnosis in the at-risk group and highlights the need to remain vigilant in patients who present with unexplained shock. Additionally, this case is a reminder of our duty to provide emergency care that transcends language barriers.

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