Objective To probe into diagnosis and treatment of splenic artery aneurysms (SAA) in patients with advanced schistosomiasis and portal hypertension. Methods Clinical data on 12 cases of SAA treated in the First Hospital of Jiaxing from January 1974 to December 2000 were analyzed retrospectively. Results One case was found by color duplex flow imaging (CDFI) and one was by BUS before operation. Other 10 cases were all found during operation period. The diameters of SAA ranged from 1.8 cm to 3.5 cm. Three aneurysms were excised together with splenectomy. Ligation of proximal and distal were done in 7 cases, one case excised the aneurysm, one case had distal ligation only and was death post-operation due to rupture of the aneurysm, after splenectomy. Conclusion The incidence of SAA in patients with advanced schistosomal portal hypertension is not very rare. If found during operation, proper management of SAA and portal hypertension is important in order to get good results.