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Aortoenteric fistula (AEF) is a rare but critical vascular condition characterized by an abnormal connection between the aorta and the gastrointestinal tract, often the duodenum, leading to potentially life-threatening complications such as gastrointestinal bleeding and sepsis. The etiology of AEF can be classified into primary and secondary types; primary AEF usually arises spontaneously, while secondary AEF is commonly associated with prior aortic graft surgery, often occurring in patients with a history of aortic aneurysm repair. Diagnosis typically involves imaging studies such as computed tomography (CT) angiography, which reveals both the aorta and the involved bowel segment, and it often requires a high degree of clinical suspicion due to nonspecific symptoms that may include gastrointestinal bleeding, abdominal pain, and signs of systemic infection. Treatment strategies for AEF are multifaceted and necessitate urgent surgical intervention, as the condition is often fatal if managed conservatively. The surgical approach usually involves a two-stage procedure: the first stage focuses on controlling the hemorrhage, which can be achieved through various methods including intraoperative endoscopy or direct visualization of the fistula. This stage may also involve temporary vascular control and restoration of hemodynamics, critical in managing these emergent cases. The second stage considers definitive repair, where the fistula is excised, and bowel continuity is restored, often necessitating resection of the affected bowel segment. Additionally, the aorta may require repair, such as placement of a new graft or patch to rectify any existing aortic injury or graft-related issues. In cases of infection or contaminated fields, a staged or delayed approach may be warranted, which involves using a vascular prosthesis and temporary bowel diversion to promote healing and reduce the risk of postoperative complications. Close postoperative monitoring is essential, as the patient may face risks such as graft infection, anastomotic leaks, or recurrent hemorrhage, necessitating a multidisciplinary approach involving cardiothoracic surgeons, vascular surgeons, and gastroenterologists. The choice of interventions may also depend on the patient's overall clinical condition, comorbidities, and the presence of prosthetic grafts, which complicate the management due to risks associated with recurrent infection or graft-related complications. Despite advances in surgical techniques and perioperative care, the prognosis for AEF remains guarded and is heavily influenced by the timing of diagnosis and treatment; early intervention is crucial for improving outcomes. Overall, awareness of this condition among clinicians, prompt recognition of symptoms, and aggressive surgical management remain vital in decreasing morbidity and mortality rates in patients suffering from this detrimental and complex vascular disorder.