Background: This study aims to better understand diagnosing and treating arterial gastrointestinal fistulas. Methods: The diagnosis and treatment of two patients with arterial gastrointestinal fistulas were reported, and the experience with diagnosis and treatment was summarized. Results: In these two cases, both patients were admitted with bleeding as the primary complaint, both underwent emergency laparotomies, and both patients were diagnosed with small intestinal bleeding before surgery. the first patient died as a result of an abdominal aortic aneurysm rupture caused by chronic vascular repair and postoperative implant infection; the second patient underwent vascular repair on time, we treated him with third-generation cephalosporin, and after he was stabilized, we performed left total iliac stent placement and left internal iliac artery embolization; he had no fever after surgery, his incision was healed, and he was successfully discharged from the hospital. Conclusion: Aortic gastrointestinal fistula is rare and has a high mortality rate, attention should be paid to distinguishing it from small intestinal bleeding. Timely diagnosis and rapid surgical treatment are keys to improving survival.