We report a unique case of an abdominal aortic aneurysm complicated by both duodenal and ureteric obstruction and review the literature on these conditions. Duodenal obstruction is a consequence of compression of the duodenum in its fixed retroperitoneal course between the aneurysmal aorta and the superior mesenteric artery. Treatment should be based on replacement of the aneurysm as gastrointestinal bypass alone does not resolve the risk of aneurysm rupture. Ureteric obstruction is related to encasement of the ureters in an inflammatory perianeurysmal fibrosis of unresolved etiology rather than secondary to aneurysm compression. Although urinary tract symptoms are often seen with aortic aneurysms, they tend to be nonspecific and are often overlooked. As many as 71% of patients with abdominal aortic aneurysms may have radiologic evidence of ureteric involvement. Although aneurysm replacement alone may resolve the perianeurysmal fibrosis with resultant relief of ureteric obstruction, most authors advise simultaneous ureterolysis. Aortic aneurysm should be considered as a possible cause of duodenal or ureteral obstruction in the elderly, especially in the presence of a pulsatile abdominal mass.