Aortoduodenal Syndrome: A Ruptured Abdominal Aortic Aneurysm Causing a Small Bowel Obstruction With Stroke-Like Symptoms

Aortoduodenal syndrome is a rare complication of abdominal aortic aneurysm (AAA) in which extrinsic compression of the duodenum results in gastric outlet or small bowel obstruction.We present the case of a 73-year-old man who presented to the emergency department with dizziness, profuse vomiting, cerebellar neurologic findings, and absent palpable lower-extremity pulses.Imaging demonstrated a large infrarenal AAA with findings concerning for contained rupture and extrinsic compression of the duodenum, resulting in gastric and duodenal dilation and at least a partial small bowel obstruction.The patient underwent emergent endovascular aortic repair with stent graft placement and was successfully discharged home on postoperative day 1.This case highlights the variable presentation of aortoduodenal syndrome, which may include gastrointestinal obstructive symptoms, hemodynamic instability, vascular compromise, and strokelike exam findings.Given the rarity of this condition, clinicians should maintain a high index of suspicion for aortic pathology when these findings occur concurrently.Although computed tomography angiography is generally preferred when feasible, the choice of imaging modality should account for patient stability, availability, and diagnostic accuracy.Prompt recognition and definitive vascular intervention are essential to prevent catastrophic complications associated with ruptured AAA.