A retrospective study was undertaken to compare the morbidity and mortality of patients who had simultaneous abdominal aortic aneurysm (AAA) resection and gastrointestinal (GI) or biliary surgery with patients who had AAA resection alone. This series consisted of 89 patients who underwent surgery over a 6-year period (January, 1980 through December, 1985) at St. Elizabeth Hospital Medical Center. The patients were separated into three groups: group 1 had elective AAA resection; group 2 had AAA resection and a GI or biliary procedure simultaneously; and group 3 had resection of a ruptured AAA. The patients in groups 1 and 2 were similar with respect to sex, age, surgeons, estimated blood loss, operative time, preoperative risk factors and hospital stay. The patients in group 3 had shorter preoperative and longer postoperative hospital stays, were older, and had greater preoperative risk. The morbidity and mortality of the patients in group 2 were consistently the same or less than that of patients in group 1, even when individual surgeons and preoperative risk factors were compared. The patients in group 3 had a significantly higher morbidity and mortality. This article reviews the literature on management of patients with simultaneous AAA and other intraabdominal pathology and presents a suggested approach to treatment.