A 71-year-old man was transferred to our institution with suspected of impending rupture of the abdominal aorta. The clinical manifestations included abdominal pain, pulsatile mass, and abdominal bruit. We made on early diagnosis of aortocaval fistula based on enhanced computed tomography and color Doppler flow imaging. Surgical repair was performed 24 hours after the onset of symptoms. At the introduction of anesthesia, cardiac arrest with high central venous pressure occurred. After resuscitation and rapid clamping of the proximal aorta, surgical closure of the fistula with graft replacement was performed successfully.