A 77-year-old female body was received through the Saint Louis University Gift of Body Program of the Center for Anatomical Science and Education (CASE) with a signed informed consent form from the donor. The CASE gift body program abides by all the rules set forth by the Uniform Anatomical Gift Act (UAGA).\nDuring routine dissection, the hilum of the left kidney was cleaned and typical anatomical structures were identified, from anterior to posterior, as the renal vein, renal artery, and superior ureteral contribution (Figures and ). Following the removal of perirenal fat, a second ureteral contribution was found exiting the kidney, slightly inferior to the hilum. The two independent contributions, superior and inferior, descended 12.4 cm and 10.6 cm before they united anterior to the left psoas major muscle to descend over the left common iliac artery to the posterolateral aspect of the bladder ().\nFurther dissection revealed an additional vascular structure, the left aberrant renal artery, entering the inferior pole of the left kidney (). Cleaning the structure revealed its origin from the abdominal aorta 4 cm inferior to the left renal artery, which branched from the aorta below the superior mesenteric artery. The aberrant renal artery was then observed travelling in parallel with, but inferior to, the left renal vein and artery toward the left kidney. This artery was also observed passing anterior to the superior and inferior ureteral contributions and bifurcated just prior to reaching the parenchyma of the inferior renal pole of the left kidney. The left ovarian artery was observed branching from the aberrant renal artery nearly halfway to the left kidney. The left ovarian artery then descended medially, but adjacent to the superior ureteral contribution, and more inferiorly, adjacent to the united ureter to supply the left ovary ().
A 36-year-old woman was admitted to our hospital with intermittent right flank pain for 4 years. The pain-free interval had been shortened when she sought medical attention. The pain was dull and confined to the right upper quadrant anteriorly and posteriorly. The pain was most often experienced during the later hours of the day, especially after ingestion of large quantities of fluid. She had been treated at a local clinic in the past for urinary tract infection with right flank pain and weakness. Physical examination revealed blood pressure of 110/80 mmHg and the presence of costovertebral-angle tenderness. Urinalysis were within normal limits (WBC 0-1/HPF, RBC 0-1/HPF). Biochemical analysis revealed blood urea nitrogen level of 11.0 mg/dL and serum creatinine level of 0.8 mg/dL.\nKidney ultrasonogram showed a marked dilatation of the right pelvocalyceal system and right proximal ureter. However, the left kidney showed normal appearance. Excretory urogram revealed a marked right hydronephrosis with dilated calyces due to ureteropelvic junction obstruction (). Computed tomography angiogram (CTA) clearly displayed the aberrant renal artery which originated from the aorta below the normal right renal artery (). A source image of magnetic resonance angiogram (MRA) also showed a severe hydronephrosis of the right kidney and smooth obstruction of the right ureteropelvic junction due to extrinsic compression by an aberrant renal artery which originated from the aorta, crossing anteriorly to the ureteropelvic junction (). Retrograde pyelogram demonstrated linear indentation of the proximal ureter (). Tc-99m DTPA renal scan revealed a markedly delayed excretion of the right kidney. After furosemide infusion, the delayed right kidney excretion was somewhat improved ().\nThe patient underwent surgical exploration via an anterior approach which revealed a slightly ptotic, mobile, right kidney which was normal in size, with a marked hydronephrotic pelvis froman aberrant renal artery and vein crossing the ureteropelvic junction, proceeding to the lower pole and compressing the ureteropelvic junction against the lower pole of the kidney. A dismembered pyeloplasty was performed, with the pelvis anastomosed to the ureter in front of the aberrant renal artery.