Rupture of splenic artery aneurysm remains an uncommon cause of hypovolemic shock although it is the third most common intra-abdominal aneurysms. It is difficult to diagnosis timely and entails a significant morbidity and mortality. We present three uncommon cases of bleeding from upper gastrointestinal tract as a result of rupture of splenic artery aneurysm to stomach in patients with liver cirrhosis or infectious endocarditis. We also reviewed the literature and these case reports highlighted that rapid resuscitation, diagnostic imaging, surgical consultation, and alternatively transarterial embolization were the priorities in the management. Early diagnosis and intervention for ruptured splenic artery aneurysm are crucial for patient’s survival; therefore, it must be kept in mind as feasible etiology of life-threatening gastrointestinal bleeding, especially in patients with underlying liver cirrhosis or infective endocarditis.
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