Anatomic anomalies of the infrarenal aorta and iliac arteries are rare. We report a 39-year-old man who presented with an ileo-cecal fistula secondary to Crohn disease. A computed tomography scan and subsequent arteriography noted his aorta bifurcated immediately inferior to the main renal arteries, at the level of the second lumbar vertebrae. Associated vascular anomalies included a common superior mesenteric artery/celiac axis plus multiple renal arteries. To our knowledge, this is the first report of this aortic anomaly in the literature.