HORSESHOE KIDNEY, in combination with an abdominal aortic aneurysm, is a rare and challenging problem in management. In the following case, surgery was deferred 5 yr before our treatment owing to the complexities of these combined pathologies. This paper deals with the detailed care of a patient while reviewing the salient features of diagnosis and treatment for abdominal aortic aneurysm in conjunction with horseshoe kidney. In a careful review of the literature, we were able to find only two cases with the above pathology so reported. Report of a Case In 1957 a 48-yr-old male was admitted to another hospital complaining of chest pain radiating down the left arm. An electrocardiogram (EKG) revealed ischemic changes which subsequently reverted to normal. Physical examination revealed a pulsating mass in his abdomen. A translumbar aortogram demonstrated an abdominal aortic aneurysm. Surgery was contemplated but abandoned when intravenous pyelography revealed a horseshoe kidney overlying