Aneurysms of the pancreaticoduodenal artery are uncommon. Only 24 cases have so far been reported. A case of clinically unsuspected, fatally ruptured pancreaticoduodenal artery aneurysm in a 64-year-old man with a five-day history of mild epigastric pain is reported. A review of the literature and brief discussion of etiologic factors and clinical presentations are also included.