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Primary aortoenteric fistula is a rare disease with a fatal outcome unless it is diagnosed accurately and treated surgically. We present an elderly patient with primary aortosigmoid fistula confirmed by endoscopy. Descending thoracic aortofemoral bypass was performed and the aortoiliac aneurysm and sigmoid colon were then resected in continuity. The patient maintains a good quality of life 6 years after the operation with good graft patency and no sign of graft infection.
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