Primary aortoduodenal fistula (PADF) is a rare cause of life-threatening digestive hemorrhage. The clinical picture is one of massive upper gastrointestinal hemorrhage with hemodynamic instability. We report the case of a 41-year-old female patient who was admitted to our department after a stay in the medical emergency department for hematemesis, hematochezia and hemodynamic instability. An abdominal CT scan was used to make the diagnosis, but due to the inadequate technical facilities for cardiovascular surgery in our hospital, she was evacuated to another hospital in Ouagadougou. Her subsequent progress was marked by her death a few days after evacuation. This case shows that in addition to the availability of diagnostic tools in our healthcare facilities, the need for qualified staff, particularly in vascular surgery, is imperative.