Our institution recently encountered two patients with ruptured iliac artery aneurysms. The first patient died, but as a result of our increased awareness, the second patient's aneurysm was diagnosed immediately and operated on successfully. The urologic findings provided subtle clues to this life-threatening condition. We present these two cases with the hope that urologic surgeons will include this condition in their differential diagnosis when evaluating patients with uncharacteristic abdominal pain and urinary symptoms.