Bilateral, fused pelvic, ectopic, laterally rotated kidneys: A case report

A congenital renal anomaly concomitant with a vascular emergency: a case of an ectopic pelvic kidney accompanied by aortoiliac aneurysms

Introduction and importance

Ectopic pelvic kidneys are an extremely rare congenital renal system anomaly. This embryological occurrence transpires between the 4th and 8th gestational weeks, and is seen in 1 in every 2100-3000 births. Moreover, research articles indicate an incidence of ectopic pelvic kidneys ranging from 0.033 to 0.047%. The co-occurrence of this anomaly with an abdominal aortic aneurysm is an even rarer finding.

Case presentation

We report a rare case involving a 62-year-old Middle Eastern male with a right ectopic pelvic kidney. The condition initially manifested as vague abdominal discomfort in the periumbilical region. The pain evolved into a continuous, localized, and insidious sensation. This was escorted by the perception of a pulsatile abdominal mass. Preoperative radiology illustrated a right ectopic pelvic kidney with concomitant aortoiliac aneurysms.

Clinical discussion

Via a successful surgical intervention, the abdominal aortic aneurysms were repaired via synthetic Dacron grafts and the renal perfusion to the ectopic pelvic kidney was secured. Moreover, the aneurysmal wall underwent a full histopathological analysis, and the results of which indicated an atherosclerotic cause.

Conclusion

Ectopic pelvic kidneys are an exceptionally rare congenital anomaly, especially when coupled with life-threatening co-occurrences like an abdominal aortic aneurysm. The need for timely surgical interventions is critical, and this topic requires comprehensive documentation as a guide for surgical professionals. This unique case is the first documented instance in the country. It emphasizes the fundamental role of proper intraoperative techniques in repairing aneurysmal conditions while preserving the function of the ectopic kidney.

Abdominal aortic aneurysm and bilateral pelvic kidneys

A 61-year-old man presented with a 5.8-cm abdominal aortic aneurysm with bilateral pelvic kidneys incidentally discovered by computed tomography angiography. Given the complex anatomy, an open approach was favored over an endovascular approach to address the aneurysm and preserve renal function. Renal perfusion was achieved with a short clamp time of 29 minutes and intermittent boluses of cold renal perfusion solution delivered into each renal artery via a Fogarty infusion catheter. We describe a rare case of bilateral ectopic kidneys in the setting of open abdominal aortic aneurysm repair using the described technique.

Bilateral pelvic kidneys with upper pole fusion and malrotation: a case report and review of the literature

BACKGROUND

The incidence of ectopic kidneys is 1:12,000 clinically and 1:900 postmortem. Patients with pelvic mal-rotated kidneys are more susceptible to recurrent urinary tract infections, recurrent renal stones, and renal injury. Fusion of the kidney lower poles is relatively common compared to other types of renal anomalies.

CASE PRESENTATION

We present the case of a 36-year-old Sudanese female patient who presented with a long history of recurrent urinary tract infections unresponsive to antibiotics. Ultrasound scan revealed bilateral pelvic kidneys. Computed tomography (CT) urography confirmed bilateral ectopic fused kidneys, with the left kidney mal-rotated (renal pelvis facing upwards and laterally). Kidney infection secondary to vesicoureteral reflux was diagnosed. Antibiotics were prescribed according to culture and sensitivity. The patient responded well to ciprofloxacin.

CONCLUSION

A history of recurrent urinary tract infections without an apparent cause is highly suggestive of renal anomaly and should be investigated expediently. Ultrasonography or CT imaging may be utilized to aid in diagnosis. Early recognition may help prevent the high risk of end-stage renal failure associated with anomalies.