Acute rupture of the inferior vena cava during nephroureterectomy is a rare but serious complication. We reported an elderly patient who had an iatrogenic injury to the inferior vena cava while undergoing laparoscopic right nephroureterectomy. He suffered from acute severe bleeding and hypovolaemic shock. The patient received blood transfusion and rapid volume therapy, and the inferior vena cava injuries were repaired successfully after an urgent laparotomy. Postoperatively, he recovered well. This case suggests that immediate intervention strategy and effective anesthesia management result in a successful outcome.