Two cases of treated iatrogenic aorto-enteric fistula are presented: one completely successfull, the other less, with exitus after five months due to aortic wall disruption. The late occurrence, operative findings, anatomo-pathological examination of the specimens, as well as the sterile (aerobic) cultures in both cases, rather favour mechanical etiological forces associated with the healing complications of aortic synthetic grafts, with or without secundary infection. Emphasis is placed on familiarity with the symptom-complex and the fact that in general the commonly available objective diagnostic tools are not a great deal more helpful in arriving at the correct diagnosis than the history and physical examination. They may even be time-consuming and lead to the demise of the patient. The importance of prevention is stressed as well as the aspects of early aggressive surgical therapy for this dismal complication.