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Rupture of abdominal aortic aneurysm is a potentially fatal event, occuring quite frequently in older men with uncontrolled hypertension. Because of nonspecific symptoms, such as abdominal and back pain, the diagnosis is difficult to make, particulary in patients with no previous history of aneurysm. We report on a patient with a ruptured abdominal aortic aneurysm and massive retro- and paraaortic haematoma, who developed a rare complication – fistula communicating with the inferior vena cava. The patient, who was in haemorrhagic shock, requierd an emergency operation. He was discharged from the hospital after 16 days of treatment.