Pseudoaneurysms of the splenic artery can occur in up to 10% of patients with chronic pancreatitis. They maybe associated with acute pancreatitis rarely. We describe a rare case of a patient presenting with a lower GI bleed resulting from a fistulous connection between a splenic artery pseudoaneurysm and the sigmoid colon after a remote episode of acute pancreatitis. A 54 year-old white man working in Haiti with a history of alcohol-related pancreatitis presented with a 1 month of intermittent blood per rectum. He was admitted to a hospital where a colonoscopy revealed a bleeding 'polyp' at 40 cm that was cauterized. No blood transfusions were given and no EGD was performed. Patient had also been complaining of 8 kg weight loss, decreased appetite and low grade fever. There was no abdominal pain. On presentation he had a low blood pressure (90/62 mm Hg). He was pale and his abdomen was soft and non tender. Rectal exam revealed blood in the vault. His WBC was 8300(mm3, hemoglobin was 5.4 g/dL, hematocrit 17.5%, and Platelets 146, 000/mm3. Serum chemistry was normal as was his coagulation profile. He was transfused 2 units of red cells. After resuscitation an EGD was performed that was reported as being normal. On colonoscopy maroonish fluid was seen in the colon with no active bleeding. The terminal ileum was normal. Angiogram of the superior and inferior mesenteric arteries revealed with no luminal extravasation. A Meckel's Scan was also normal. Next morning, on enteroscopy prominent gastric fundal folds suggestive of isolated gastric varices were visualized. Suspecting a splenic vein thrombosis a CT scan of the abdomen was ordered revealing a 3.5 × 3.5 cm splenic artery 'false' aneurysm with thickened sigmoid colon wall and extravasated fluid (blood) around it suggestive of an aneurysm communicating with the large bowel. During surgery, a splenic artery pseudoanuerysm, splenic vein thrombosis, a large retroperitoneal hematoma and a fistulous connection between the sigmoid colon and splenic artery were seen. He underwent a splenectomy, left hemicolectomy, ligation of the splenic vessels and partial pancreatectomy and made an uneventful recovery. Hemorrhage from splenic pseudoaneurysms has been reported in up to 37% of patients. Mortality for treated patients is 10–33%. The type of surgery depends on location of the aneurysm. Transcatheter arterial occlusion or selective embolization maybe used by interventional radiologists for non-surgical management.