The Authors report a case of syrnptornatic large rnidsplenic artery aneurysrn (ASA) in a 58-years-old man. The symptoms were: continous epigastric pain with irradiation to the left hipochondrium. First they consider etiopathogenetic factors: arterial fibrodysplasia, portal hypertension, infiammatory process of the vessel wall, pregnancy and correlate hormonal hemodynamic events. Finally they analyze diagnosis and tirning of the surgical treatment; particulary exclusion or resection of the ASA is raccomended for symptomatic or ruptured aneurysrn, even for wornen of childbearing age. Embolization is considered the choice treatment of ASA in high-risk patients.