Vesicovaginal fistulas are devastating conditions for the affected women. The combination of a hysterectomy and radiation increases the fistula risk 5-10 times. Radiation-induced recurrent vesicovaginal fistulas have the lowest success rate and require the most demanding treatment. We present the case of a recurrent post-radiation vesicovaginal fistula treated with a small intestine graft after unsuccessful conservative and failed previous operative treatments. The surgical management with a small intestine graft led to a permanently closed fistula. We describe the surgical abdominal procedure step-wise and review the rather scarce, post-radiation fistula literature. The closure of a vesicovaginal fistula with a small intestine graft is a complex surgical treatment with a long-term, successful result.