Most patients are unaware of their abdominal aneurysm until it is incidentally discovered by their physician. The importance of careful deep palpation of the abdomen cannot be overemphasized. On occasion, these aneurysms may expand, causing abdominal or back pain, and may even leak or rupture, mimicking other acute intra-abdominal conditions. Signs and symptoms of acute ischemia in the lower extremities are rare and usually follow thrombosis or embolization from an abdominal aneurysm.