Osteomyelitis pubis is a rare condition and can be difficult to distinguish from osteitis pubis, a non-infectious inflammatory process. Though rarer still, a secondary entero-articular fistula should be considered when intra-articular and intra-muscular gas is present without an overlying soft tissue defect. This was further supported by cultures positive for bowel flora. The fistula was occult on oral contrast CT and could only be confirmed via a fluoroscopically-guided arthrogram.