In the past, vascular prostheses have been developed for mesocaval shunt surgeries in the treatment of portal hypertension. Penetration of prosthesis into the duodenum is a rare complication. We report the case of a 65-year-old man who presented with duodenal erosion and obstruction caused by the prosthesis, 22 years after its insertion. This is the ninth reported case of such events, but it demonstrates the longest interval to date between insertion and complication.