Key Clinical MessageIliac artery‐enteric fistula is a rare cause of lower GI bleeding and can cause life‐threatening consequences. A high degree of clinical suspicion is needed in patients with previous aortic surgery to allow early multidisciplinary intervention.AbstractThis case study discusses the staged management of a 78‐year‐old patient presenting with life‐threatening lower gastrointestinal (GI) bleeding secondary to an aortoiliac graft‐enteric fistula (GEF) into the sigmoid colon on the background of an adenocarcinoma and diverticular disease. The patient had an aorto bi‐iliac synthetic dacron graft repair of an abdominal aortic aneurysm (AAA) some 20 years ago. Here, we present a case of successful endovascular treatment of massive hemorrhage as a bridge to definitive second‐stage dacron graft explant and autologous vein reconstruction with a simultaneous anterior resection.