The existence of a common iliac and internal iliac artery aneurysm is rare. The rupture of the internal iliac artery aneurysm into the rectum from the formation of ilio-rectal fistula causing torrential bleed per rectum is very rare with high mortality and demands immediate intervention for survival. Lower gastrointestinal Bleeding (LGIB) in the tropics is most likely to be a young individual commonly bleeding from nonspecific or enteric ulcers. In contrast the western patient with massive LGIB is likely to be an elderly individual bleeding from diverticulosis or angiodysplasia.A 65 year old patient who was been investigated for intermittent rectal bleeding had a torrential and exsanguinating rectal bleeding during examination under anesthesia in theatre. He had to be resuscitated and further invested with a CT Angiography which showed an aneurysm of the right common and internal iliac arteries fistulating into the rectum. He was stabilized and underwent an uneventful aneurysmectomy and femoro-femoral Goretex bypass. He has been well two years after surgery with no sequelae.
