Appendico-ileal fistula is a rare condition with acute ileus. We report a case of appendico-ileal fistule in a 46-year-old man patient who has undergone laparatomy for intestinal mechanical obstruction. Intraoperatively, an appendix with a lumen was found with a fistula to the terminal ileum. It has been observed that proximal ileal and jejunal intestinal anses were distended. Appendectomy, segmental ileum resection and end-to-end anastomoses were performed as a surgical procedure. This case describes an elderly man with acute ileus presenting with small bowel obstruction. We conclude that, appendico-ileal fistula should be kept in mind in cases with acute ileus presenting with small bowel obstruction.