Thirty-eight patients with aneurysms of the splenic artery were identified in the records of 11 years, but only one aneurysm was ruptured. Portal hypertension was found in nine patients (24%); in two of these the reaction surrounding the aneurysm prevented the construction of a patent splenorenal shunt or caused compartmented portal hypertension. One aneurysm encountered during the survey period and another encountered just after its conclusion ruptured into the stomach. There was a twofold overrepresentation of multiparous women. Intraperitoneal rupture is rare, except in pregnancy. If elective therapy is considered, angiography should be performed. Exclusion or resection of the aneurysm is advocated only for patients with symptomatic or ruptured aneurysms or (very rare) large aneurysms and for women of childbearing age. The spleen should be preserved, when possible. In high-risk patients occlusion of the aneurysm via an intra-arterial catheter should be considered. If the splenic artery aneurysm causes compartmented portal hypertension, splenectomy is indicated; if portal hypertension is general, the form of portasystemic decompression chosen should avoid the region of the aneurysm.