An 81-year-old woman who had undergone total hysterectomy and postoperative radiotherapy for uterine cervical cancer 45 years earlier visited Department of Urology in our hospital with the chief complaint of diarrhea and pain of the perineal region. Vesico-recto-vaginal fistula with pyelonephritis was diagnosed by a plain CT scan. Her general condition improved by antibiotics and percutaneous nephrostomy. However, urine and fecal fluid still flowed from the vagina, and she complained of marked pain at the perineal region due to erosion and ulcer. She was referred to our department to resume oral ingestion and to improve ADLs. Ileo-vesical fistula was also diagnosed by a plain abdominal CT scan with oral contrast medium on the 16 th hospital day. Laparotomy revealed firm bowel adhesions with multiple loops and radiation enteritis in the pelvic cavity. Considering that division of the adhesions might entail a high risk of bowel injuries, we performed a by-pass anastomosis of the small bowel and mode a transverse colostomy. Defluxion of digestive fluid from the vagina considerably reduced and the patient was discharged from our hospital on the 55 th postoperative day. Entero-vaginal fistula is a rare disease, especially, small bowel-vaginal one in extremely rare. This paper presents a case of ileo-vesico-recto-vaginal fistula caused by late complication of radiotherapy, together with some discussion on the literature.