We report the case of a successful treatment of a splenic artery aneurysm by aneurysm excision and direct splenic artery reconstruction allowing spleen conservation. This aneurysm was related to an arterial wall medianecrosis. Because of the reappraisal of the splenic immunological function, we believe as others that this surgical management can be a new alternative to splenectomy as treatment of splenic artery aneurysms.