The absence of the inferior vena cava is an uncommon congenital anomaly and can be misdiagnosed. We report a 14-year-old boy initially admitted as a result of a painful abdominal mass; after admission, he experienced a deep venous thrombosis in his left leg. Subsequent evaluation revealed the congenital absence of the entire inferior vena cava, with a cluster of thrombosed collateral veins in his right pelvis, corresponding to the abdominal mass. The recognition of this anomaly may be helpful in the event of differential diagnosis in retroperitoneal masses. In young patients with idiopathic deep venous thrombosis, an inferior vena cava anomaly should be considered.

Patients with an infrarenal venous anomaly are relatively rare, but are most likely to suffer bleeding from an injury during abdominal aortic surgery. During the last five years, we have performed nine abdominal aortic surgeries with major venous anomalies. There was no severe haemorrhage and actually, after 3-53 months (median 28 months) all the patients have done well. Preoperative assessment and intraoperative awareness are important to prevent unexpected injuries and subsequent excessive bleeding. If the venous anomalies are recognized and treated correctly, serious injuries can be prevented and the outcome should not be affected. In elderly patients, with severe comorbidities or inflammatory aneurysms, an endoprosthesis is preferred.

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