Background: Isolated splenic vein bleeding without an intra-capsular splenic hemorrhage in the absence of trauma is extremely rare and not reported widely in the literature. We aim to describe a rare case of spontaneous, atraumatic peri-splenic hemorrhage to highlight the management dilemmas associated with the condition. Case Report: A 72 year-old gentleman presented with acute onset epigastric pain and nausea. His past medical history included portal vein thrombosis secondary to thrombocytosis for which he was on aspirin, and a deep vein thrombosis (DVT) and pulmonary embolus treated with warfarin. CT scan revealed a hemo-peritoneum and hemorrhage from peri-splenic veins. After failed conservative management he underwent a laparotomy for control of the bleeding. Post-operatively he developed an extensive DVT leading to limb ischemia and subsequently passed away. Conclusion: Peri-splenic venous hemorrhage in the absence of trauma is an extremely rare occurrence and is potentially fatal.