Aortoenteric fistulas are serious and life-threatening complications of aortic surgery. Their exact pathogenesis is unknown, but mechanical erosion or infection leading to suture line failure are likely mechanisms. The presentation of an aortoenteric fistula can be seen months to years following the original operation, and clinical suspicion remains the cornerstone for diagnosis. When it is suspected, a prompt diagnostic work-up should be pursued in the absence of a readily recognizable source of hemorrhage. Once it is found, either by diagnostic studies or emergency laparotomy, repair can be accomplished by in situ graft replacement or extra-anatomic bypass with closure of the aortic stump. Thorough debridement of the aorta and perigraft tissues is essential for success and patient survival. As perioperative preparation and surgical techniques evolve, so too will the controversy concerning the optimal method for repair.