Objective: Pregnancy is cited as the most important risk factor for splenic artery aneurysm (SAA) rupture, but the true rupture rate of SAAs during pregnancy is unknown. Our objective was to evaluate the prevalence of SAAs, based on diagnostic and procedural codes, in an urban population treated in a county hospital with the highest number of births in the United States. We hypothesized that SAA rupture in pregnant women is very low and that SAAs are more likely to be diagnosed in older patients. Methods: Patients diagnosed with a SAA during a recent 5-year period were identified using International Classification of Diseases-Ninth Edition, Clinical Modification, and Current Procedural Terminology (American Medical Association, Chicago, Ill) codes. Demographics, imaging, and risk factors for rupture were reviewed. Results: We identified 35 patients with SAA. Patients were a median age of 63 years (interquartile range [IQR], 54-74 years), and 28 (80%) were women who were a median age of 62 years (IQR, 54-74 years). The SAAs in the 35 patients were a median size of 1.3 cm (IQR, 1-1.9 cm), and eight (23%) were >2 cm. Despite the very large number of deliveries recorded during the study period (67,616 births), no women who were pregnant or aged <45 years were identified. However, 89% of women with an SAA had previous pregnancies. Two women and one man (8.6%) experienced rupture, resulting in one death (2.9%). More than one imaging study was available for 19 patients (60%) without intervention for a median of 32 months (IQR, 7-76 months), with no significant change noted. Three patients underwent elective repair due to size criteria. Six patients (17%) had concurrent aneurysms, including three renal artery aneurysms, one aortic aneurysm, and three intracranial aneurysms. No risk factor for enlargement or rupture was particularly prevalent. Conclusions: Ruptured SAAs are exceedingly rare in young women, and no ruptured SAA were identified during pregnancy in this study. SAA are frequently diagnosed as an incidental finding in middle-aged adults and tend to remain stable over time in this population.