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.
A 42-year-old male cadaver, with history of prolonged hypertension and death due to cardiac arrest, was dissected routinely. No gross variation was seen in the cadaver. After opening the abdomen a left pelvic kidney was found at the pelvic brim with its medial end in front of sacral promontory close to the bifurcation of the right common iliac artery. First its location, position, and dimensions were analysed and compared to the right kidney. The right kidney appeared normal in position. The dimensions of the left kidney were 13.5 × 6.5 × 2.5 cm, larger than the right kidney whose dimensions were 12 × 5 × 2 cm. The left ectopic kidney was lobulated. Location: the upper pole of left kidney was located at the level of sacral promontory resting over psoas major muscle and inferior pole was present at the S3-S4 intervertebral space. The hilum was anteriorly placed, open with contents exposed to the surface as seen in . The inferior mesenteric artery was arching over the hilum. Three major calyces receiving two minor calyces were visible externally. Superior major calyx was seen reaching the upper pole while middle and inferior major calyces were seen close to the hilum all converging to form pelvis of ureter. Normal hilar relation was disturbed. At the hilum the renal pelvis was present anterior to the inferior left renal vein. The left ureter was tortuous and just 12 cm in length. Both suprarenal glands were present at the level of 12th thoracic vertebra. Blood supply: the left kidney was vascularised by three branches. The first branch arose from the bifurcation of aorta at the level of L4 vertebra; it was 4.5 cm long and descended obliquely to superior pole of kidney. The second branch was 2.5 cm and arose from the right common iliac artery at a slightly lower level (L4-L5) and was seen passing to superior pole. The third branch was 4.3 cm long arising at S5 level from left inferior vesical artery. The ectopic kidney was drained by two renal veins which drained into the right common iliac vein. The superior left renal vein accompanied the second renal artery while the inferior left renal vein emerged through the hilum.\nThe left suprarenal gland was supplied by left inferior phrenic artery and from direct branches from aorta. The left gonadal vein drained directly into the inferior vena cava rather than draining into the left renal vein. Left suprarenal vein drained into IVC.\nThe right kidney was at the normal position. However the hilum was present anteriorly and a bifid renal pelvis could be seen which was also malrotated. Its vascularisation was by a single renal artery originating from aorta. A single renal vein was seen draining into the inferior vena cava. No gross variation was seen in the cadaver.