We describe a case of successful surgical treatment for spontaneous rupture of an iliac artery aneurysm into a ureter. An 80-year-old man was admitted with massive hematuria. Immediate enhanced abdominal computed tomography scan and cystoscopy were suspicious for a uretero-arterial fistula caused by aneurysmal rupture. Emergent surgical intervention was performed because of the high mortality rate of this condition. Intraoperative findings revealed the fistula between the true aneurysm of the right common iliac artery and the ureter. Repair of the aneurysm and ligation of the ureter was performed, with an uneventful postoperative course.