Isolated aneurysms of the iliac arteries are rare. Located deep in the lesser pelvis, they are diagnosed late or in a symptomatic stage. Because of their manifold anatomic relationships to pelvic structures, iliac aneurysms may cause different symptoms such as obstipation, hydronephrosis, venous thrombosis, and entrapment neuropathy. Aneurysm rupture is associated with high mortality. The rupture of an iliac aneurysm into the rectum with massive lower intestinal bleeding is extremely rare. We report a patient with 6-year follow-up after aneurysm resection, extra-anatomic bypass, and suture repair of the rectum with temporary colostomy.