Abstract
Few rare complications of the abdominal aortic aneurysm and its management are combined together in a single case in which breathlessness of congestive cardiac failure resulting from an aortocaval fistula was the presenting complaint. Five weeks following a successful repair, the patient developed persistent chylous ascites initially refractory to conservative treatment, shunting, and external drainage. The condition was further complicated by perforated cecum, recurrence of the fistula, and bleeding duodenal ulcer, which were surgically treated by three separate laparotomies. Eventual full recovery lasted for only three and half months, after which the patient died by rupturing his thoracic aneurysm.