Background: Aneurysms of the superior mesenteric artery (SMA) and its branches are uncommon complication of infective endocarditis (IE) and have a high rate of rupture and mortality. Case Report: A 50-year-old female was diagnosed and treated for IE with good initial evolution. During pre-surgery evaluation, the patient developed hemorrhagic shock. Computed tomography angiogram revealed hemoperitoneum and contrast extravasations due to rupture of aneurysm originating from an SMA’s branch. The patient was transferred for urgent surgery. On laparotomy large, inflamed, pulsatile mesenteric mass with free blood in the pelvis was found. Evidence of necrotic small bowel was detected and resection of 25 cm with ileostomy was performed and surgery for restoring bowel continuity after ileostomy was programmed three months later with good results. Conclusion: Although main trunk and superior mesenteric artery (SMA) branch aneurysms account for only 5.5% of all visceral artery aneurysms, early identification and expedient management are very important given an associated 38-50% rupture rate and 30% mortality.