Background: The operative management of abdominal aortic aneurysm (AAA) and co-existing intra-abdominal malignancy has been a long-standing controversy. It is unclear whether a single-stage or a two-stage approach is the more appropriate therapeutic option and also which lesion should be treated first. Case outline: An 82-year-old man with a 4×5-cm mass in the left liver (segment IV), suspected to be a hepatocellular carcinoma (HCC), had a concomitant 6-cm infrarenal AAA. At the same operation he underwent a left hepatectomy followed by repair of the aneurysm. He was discharged on the 17th postoperative day. To the best of our knowledge, this is the third report in the world literature of a patient who underwent a successful simultaneous resection of an AAA and HCC and the first in which the liver resection was performed first. Discussion: We recommend liver resection and AAA repair in a single-stage procedure, regardless of the time sequence of the procedures. This approach can be considered safe, and the theoretical risk of graft infection can be kept to a minimum
