Aortoenteric fistulas are rare (<1%) but disastrous complications after open and endovascular aortic surgery. The most frequently involved anatomical sites are abdominal aorta and duodenum. Surgery is the only possible treatment and consists, in most of cases, in an axillobifemoral bypass, a very invasive procedure with a high rate of complications. In the literature, less than 10 cases of direct communication between the right iliac artery and the appendix are described. In this paper, we discuss our experience of a case of iliac appendiceal fistula. We go through clinical presentation, diagnostic path and treatment with a brief look at the literature. Our conclusion is that in some cases a less invasive surgical approach could lead to good results, but the long-term outcomes need to be studied. Iliac appendiceal fistulas are rare variations of aortoenteric fistulas with similar onset. In cases like ours, a less invasive surgical approach could lead to good results.