Acquired arterio-venous fistulas of the superior mesenteric artery are a rare event following abdominal injuries or surgery. Clinical symptoms present as cramplike abdominal pain and diarrhea with a history of previous laparatomy or a penetrating abdominal trauma. The clinical examination may reveal a paraumbilical pulsation with flow murmur. The exact localization and the extent of the a.-v.-fistula may be established by selective arterial mesentericography. An urgent vascular reconstruction is indicated in order to prevent secondary alterations due to portal hypertension. Apart from vascular surgery, successful percutaneous catheter embolization has been reported.