Arterial-enteric fistulas are a rare but devastating complication that can occur as a result of surgery or radiation exposure. Although this condition is most frequently seen following manipulation of the vasculature, especially in the presence of the vascular graft, other causes have been reported. Twenty-five cases have been reported in the literature, mostly related to previous vascular grafts. We present a case of ileal artery to sigmoid colon fistulas caused by previous resection of bladder cancer and radiation.