ABSTRACT
John J. Ricotta and Paul S. van Bemmelen Much of the available literature on concomitant intra-abdominal surgery predates
minimally invasive procedures such as ERCP and laparoscopic cholecystectomy. Furthermore, rapid changes occur in diagnostic imaging technology, which lead to new and different coincidental findings during the work-up o f various intra-abdominal conditions. Management of intra-abdominal pathology encoun tered during aortic surgery is based on anecdote and personal experience more than it is on hard data. The coexistence of aortic and other intra-abdominal pathology is uncommon enough that no large or randomized series exist to provide level one data for the clinician. Rather, therapeutic decisions must be made based on clinical assessment of several factors. These include relative severity of the aortic and nonaortic conditions, risk of aortic graft infection (which should be considered a highly lethal complication), risk o f aortic rupture if aneurysmorrhaphy is delayed, indication for concomitant procedure (prophylactic versus therapeutic) and complexity of the pro posed procedure. In each case, the goal should be to minimize patient risk while avoiding an unnecessary second operation. The ensuing chapter will discuss ratio nale for a selective approach to these problems.
