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We report the first case of duodenal-inferior vena caval (IVC) fistula resulting from locally recurrent renal cell carcinoma (RCC). A 45-year-old man presented with gross hematuria and underwent a right radical nephrectomy to treat a solid renal mass. Histologic evaluation showed RCC, State pT3aNOMO. The patient presented 21 months later in hemorrhagic shock, with upper gastrointestinal bleeding....