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Ectopic kidney is a congenital anomaly of renal position, which is commonly asymptomatic. Symptoms arising from pelvic kidneys can closely mimic pathological processes of nearby organs and vice versa. We report an 18-year-old girl who presented with acute onset of a painful lump in the right iliac fossa. Although the clinical features mimicked an appendicular abscess, the judicious use of cross-sectional imaging aided in the proper diagnosis. Pyonephrosis of a right-sided lumbar kidney was confirmed on further imaging and nephrectomy was performed. This case has been presented to highlight the significance of renal imaging in patients suspected of an appendicular abscess.

The natural location of the kidney is the loin and the fascial sheaths around it gives it inherent protection against trauma and various other diseases. While there is enough evidence for fascia around well ascended normally located kidneys, there is very little evidence for its presence in ectopic pelvic kidneys. This evidence-based review discusses the recent changes in concepts regarding renal and perirenal fascia in normal and ectopic kidneys. The perirenal fascia was described as anterior and posterior layers that fuse laterally to form the lateral conal fascia. However, subsequent studies have shown that these fasciae are multi-laminated structures that blend and fuse with underlying muscles. However, in pelvic kidneys, the anterior and posterior renal fascia is not so well-documented. The medial extension of the enlarged kidney enables an easy cross-over to the opposite side. A subcapsular urinoma or a perirenal hematoma is usually self-contained in a closed space, owing to the attachments of the renal capsule and the perirenal fasciae. The hematoma in such closed space acts as a self-tamponade, preventing further blood loss or hemodynamic instability. Computed tomography has enhanced the understanding of perirenal space and pathologies. Tri-compartmental theory formed the basis for a clear understanding of these fasciae. A better knowledge of these fascial planes helps the surgeons to identify the avascular planes, better. A larger prospective study is needed to get further insights into renal fascia in pelvic kidneys.

Extrarenal calyces (ERC) is a rare renal anomaly where calyces lie outside the renal parenchyma and are connected to pelvis by draining infundibulum. Its presentation with pelviureteric junction obstruction presents a confusing intraoperative finding. We report two cases of ERC with pelviureteric junction obstruction in the ectopic kidney. Emphasis is laid on the defining the anatomy so that reader can identify the condition if he comes across similar situation. The two patients were managed by minimal access approach. Management of these cases and review of pediatric cases reported in literature are discussed.

The occurrence of pelvic malignancies along with an ectopic kidney is a rare finding. In the patients of early stage carcinoma of cervix presenting with pelvic kidney, surgery is preferred to radiation to avoid irradiating the kidney. However, advanced stage carcinoma of cervix in such scenario poses a therapeutic dilemma and conformal radiotherapy in the form of intensity-modulated radiotherapy (IMRT) is preferred option. This helps to achieve the desired dose to the target while reducing the dose to the surrounding organs at risk particularly to the pelvic kidney. Herein, we present a case of International Federation of Gynecology and Obstetrics Stage IIB carcinoma of cervix having ectopic right pelvic kidney in a 40-year-old female, and the patient was successfully treated with chemoradiotherapy in IMRT technique. The patient is disease free with normal renal function at 2-year follow-up. The previously reported cases of pelvic malignancies with ectopic kidney in the literature are discussed here briefly.

The pelvic kidney is the most common type of renal ectopia. It is clinically asymptomatic in general but are more prone to the urinary infections. It has also been associated with an increased risk of nephrolithiasis. The 37-year-old man was admitted to the emergency room with complaints of left flank pain, nausea and vomiting. In addition to this flank pain, the patient had an intermittent pain in the lower abdomen and pelvic region for 6 years with no history of fever. The renal ultrasound demonstrating several shadowing echogenic areas consistent with nephrolithiasis in both kidneys. In addition, while the right kidney was in the normal size and location, the left kidney was located on the ectopic site, just above the bladder. Doppler examination revealed double renal arteries originating from the aorta on the right side. Our case indicates the importance of the ectopic pelvic kidney location when planning surgical procedures in patients with renal and pelvic pathology, kidney transplantation and nephrectomy.

Background: The pattern of pediatric kidney diseases varies from one region to another because of genetic, racial, and environmental differences. This study was aimed at determining the pattern of renal diseases among children presenting at the pediatric nephrology clinic of the hospital. Subjects and Methods: It was a retrospective study of all children aged less than 15 years seen at the pediatric nephrology clinic of the hospital over a period of 30 months. The records of 244 patients seen at nephrology clinic over the period of study were retrieved and studied. Results: There were 155 males (63.5%) and 89 females (36.5%), with a male to female ratio of 1.7:1. The ages ranged between two months and 179 months, with a mean age of 104.8 ± 46.7 months. Nephrotic syndrome was the commonest renal disease and accounted for 33.6% (n = 82) of all cases, followed by acute glomerulonephritis with 25.8% (n = 63). Acute kidney injury and chronic kidney disease follow with frequencies of 34 (13.9%) each. The commonest congenital anomaly of the kidneys was ectopic kidney with 12 cases (4.9%). Conclusions: Our data reflects a high burden of renal diseases among children in our environment, and also reflects variations in regional patterns. The need for improvement of pediatric renal services and training of health workers in early detection and treatment of these conditions cannot be overemphasized.

Ovarian dermoid cysts are made up of solid, cystic, and fat tissue arising from two of the three germ layers. The incidence of they being bilateral is rare and accounts for 10%–15%. A 42-year-old female came with chief complaints of increased bleeding during menses and pain in the abdomen. Ultrasonography revealed echogenic lesion with heterogeneous echotexture in both the ovaries with internal echogenic strands within which was s/o bilateral dermoid cyst. The patient had a left ectopic renal kidney on contrast-enhanced computed tomography of the abdomen; there was well–defined, rounded, mixed-density mass lesion seen in the pelvis showing fat density, areas of calcification (Rokitansky protuberance), soft tissue, and fluid components. After postoperative and histopathological correlation, it was found to be bilateral dermoid.

Bochdalek hernia is a congenital abnormality with high morbidity and mortality characterized by passage of the abdominal organs into the thoracic cavity through a diaphragmatic defect. Intrathoracic location of abdominal organs such as kidneys is very rare, with a reported incidence of only 0.25% in the literature. Herein, we present two cases of Bochdalek hernia with a herniation of intra‑abdominal organ such as kidney that was treated in our clinic and compare this rare case with those in the literature. In both cases, the functionally normal kidneys were left in situ during diaphragmatic repair. No complications were observed during the postoperative period, and 10‑ and 1‑year follow‑ups. In cases with Bochdalek hernia associated with an intrathoracic ectopic kidney, the functionally normal ectopic kidneys were left in situ during repair of the diaphragmatic defect without complications.Keywords: Bochdalek hernia, intrathoracic ectopic kidney, review of literature, two case reports

Cadaveric donors with congenital renal anomalies are often refused because of technical difficulties. As the waiting periods for kidney transplants continue to increase, transplant centers need to consider them also as potential donors. This paper describes transplantation of a crossed fused disc type ectopic kidney to two patients with end-stage renal disease, after parenchymal transection. The transplants were successful with minimal complications, and the recipients had immediate graft function. It is now one year from transplantation, with excellent renal functions.

Renal artery pseudoaneurysm is a very rare complication after blunt trauma. Congenital anomalies like horseshoe kidney, ectopic kidney, pelvi-ureteric junction obstruction, etc., make it more vulnerable to trauma. We report a case of a 21-year-old male admitted to our hospital 3 days after blunt abdominal trauma with complaints of lower abdominal pain, hematuria, and hypotension. The diagnosis of ectopic right kidney with interlobar laceration was established by ultrasonography. Computed tomography angiography showed interlobar renal artery pseudoaneurysm in ectopic right kidney. Successful superselective endovascular coil embolization of the pseudoaneurysm was performed.

Purpose: Patients with deranged renal functions have a number of associated factors which can impair healing of wound and increase postoperative morbidity. This study was conducted to assess the problems while managing ectopic pelvic kidney calculi using laparoscopic approach for percutaneous nephrolithotomy (PCNL) in chronic kidney disease patients. Subjects and Methods: Patients with calculi in ectopic kidney with increased serum creatinine level secondary to obstruction were included in the study. Initially, obstruction was relieved. Patients later underwent laparoscopic-assisted PCNL. Patients were monitored postoperatively. Results: Three patients with large renal calculi in ectopic pelvic kidney had presented in 2 years. Laparoscopic-assisted PCNL was done to remove the stone. Patients had persistent urine leak post-operatively. Mean duration for removal of nephrostomy tube and drain removal were 4.67 days and 6.67 days, respectively. These patients also had paralytic ileus for prolonged duration. Conclusion: Although laparoscopic assisted PCNL is an option in the management of patients with stone disease in ectopic pelvic kidney, prolonged time for healing of tract may increase postoperative morbidity in these patients with impaired renal function.

Objective: The purpose of this study was to characterize the renal abnormalities with renal scintigraphy in patients with high anorectal malformation (HARM). Patients and Methods: We retrospectively reviewed 53 patients who had undergone corrective surgery for HARM from July 2011 to January 2017 and who were referred to this department for Technetium-99m dimercaptosuccinic acid (Tc99m-DMSA) scan for evaluation of renal cortical scarring. Scintigraphic evaluation of all 53 patients included both dynamic renography [Tc-99m diethylene triamine penta acetic acid (DTPA) and Tc-99m-L, L-ethylenedicysteine (L-EC) scan] and cortical scintigraphy. A total of 68 scans were done in these 53 patients in which there were 38 Tc-99m DMSA scans, 15 Tc-99m DTPA and 15 Tc-99m EC scans. Tc-99m DTPA scans were done in 15 patients (26 kidneys) to look for glomerular filtration rate and drainage pattern. Results: Mean age of presentation of these 53 patients (86 kidneys or renal units) with HARM was 28.9 months. Out of 53 patients, male comprised 62.26% of cases (n = 33) and female comprised 37.7% of cases (n = 20). Spectrum of urologic abnormalities noted in our patients with HARM included unilaterally non-visualized kidney in 37.7% cases, i.e., 20/53 patients; hydroureteronephrosis in 28.3% of cases, i.e., 15/53 patients; hydronephrosis in 16.98% cases, i.e., 9/53 patients. Scarring was noted in 28.3% cases, i.e., 15/53 patients. Small kidney was noted in 10 patients out of 53, i.e., 18.8% of cases. Ectopic kidney was seen in 5.6% cases, i.e., 3/53 patients, horseshoe kidney in 3.7% (2/53) and duplex kidney was found in 1 patient, i.e., 1.8% of cases. Conclusion: Children with HARM have a high incidence of renal anomalies and these are the most common cause of morbidity and mortality in these patients. It is important to document these renal anomalies early in life and initiate management as early as possible. Apart from routine investigations, such as ultrasound, renal scintigraphy performed with Tc-99m DTPA, Tc-99m EC and Tc-99m DMSA-III are non-invasive investigations that may provide important help in diagnosis, follow-up and management of renal anomalies in these patients.

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Introduction: The treatment of renal lithiasis has undergone a sea change with the advent of extracorporeal shock wave lithotripsy (ESWL) and endourological procedures such as percutaneous nephrolithotomy (PCNL), ureterorenoscopy and retrograde intrarenal surgery (RIRS). The presence of anatomical anomalies, such as ectopic pelvic kidney, imposes limitations to such therapeutic procedures. This study is aimed to find a simple and effective way to treat the stones in ectopic kidney. Materials and Methods: From 2010 to 2014, nine patients underwent laparoscopic-assisted mini PCNL with Laser dusting for calculi in ectopic pelvic kidneys at our hospital. Retrograde pyelography was done to locate the kidney. Laparoscopy was performed and after mobilizing the bowel and peritoneum, the puncture was made in the kidney and using rigid mini nephroscope, and stones were dusted with Laser. Results: The median interquartile range (IQR) stone size was 18 (6.5) mm. Median (IQR) duration of the procedure was 90 (40) min. The median (IQR) duration of postoperative hospital stay was 4 (2) days. The stone clearance in our series was 88.9%, with only one patient having a residual stone. No intra- or post-operative complications were encountered. Conclusion: Laparoscopy-assisted mini PCNL with Laser dusting offers advantages in ectopic pelvic kidneys in achieving good stone clearance, especially in patients with a large stone burden or failed ESWL or RIRS.

A 5-year-old girl presented with continuous wetting with normal voiding pattern since birth. Ultrasonography (USG) showed a solitary left kidney. Excretory urography showed a normal left kidney. Right kidney was not seen but lower ureter was faintly delineated. Hence, contrast enhanced computed tomography (CECT) was done to look for any right kidney which was not seen on USG. CT showed a normal left kidney with a small ectopic kidney in right hemipelvis but ureteric orifice could not be traced to its insertion. Dimercaptosuccinic acid confirmed it to be a poorly functioning (6%) ectopic right kidney. Cystourethroscopy and vaginoscopy done could not localize the right ureteric orifice. The child underwent right nephrectomy along with excision of ectopic ureter inserting into vagina with complete resolution of her symptoms.

Diaphragmatic hernia of Bochdalek (BH) and intra-thoracic kidney (IK) are both rare congenital, developmental anomalies. In some extremly rare occasion, these two congenital anomalies can be associated in the same patient. The kidney typically exits the retroperitoneal space through the foramen of Bochdalek. The majority of IK and BH are discovered incidentally. A conservative approach can be proposed in asymptomatic cases. In this report, the case of a 35-year-old man presenting with 1-week of acute abdominal pain is presented. Chest radiography revealed a posterior mass in the right hemithorax, which was later confirmed by chest computed tomography and magnetic resonance imaging to be a congenital IK associated with a BH.

Ectopic kidney occurs as a result of cessation in migration of kidneys to their usual position in the lumbar region. Several cases have been reported worldwide, however only one case of ectopic kidney in infant has been reported in North Western Nigeria which was not a pelvic kidney. We present an incidental case of unilateral ectopic pelvic kidney managed in our facility. A 28-day-old male infant presented with a week history of crying while defecating and fever. He had normal abdominal findings. Abdominal ultra sound scan revealed a unilateral left ectopic pelvic kidney with no associated abnormalities. Full blood count showed elevated white blood cell count predominately neutrophils. He was managed as a case of neonatal sepsis with antibiotics. A thorough antenatal ultrasonography and early neonatal ultrasound are required for early diagnosis. Asymptomatic and noncomplicated cases are managed conservatively.

A thirty-year-old fertile man with a history of right-sided cryptorchidism presented to the surgical outpatient department with a right iliac fossa mass of two months duration. On computed tomography scan of the abdomen, diagnosis of malignant testicular mass with right ectopic kidney and eventration of right hemidiaphragm was made. Exploratory laparotomy with surgical resection of mass was done, which was histopathologically diagnosed as seminoma of the right testis. The unique developmental anomalies and associated seminoma made us report this case. These developmental anomalies may be a possible sequence of events or merely a coincidental combination.

We report a case of a 55-year-old woman, who presented with a vague pelvic pain and was found to have an ectopic pelvic kidney involved by a mass. Preoperative assessment was done by multi-slice CT and 3D-CT angiography. According to our knowledge only eight cases of pelvic kidney tumor have been reported in the literature and our case is the first report of using multi-slice CT and 3D-CT angiography in the preoperative evaluation of these cases.

Introduction: The Mayer-Rokitansky-Kuster-Hauser (MRKH) syndrome is one of the most common causes of primary amenorrhoea and is associated with vaginal atresia and absent uterus despite the presence of normal ovaries and external genitalia. Various techniques have been used, with many disadvantages, to create a neovagina. Aims and Objectives: Our aim is to create a neovagina with a simple and safe method. Materials and Methods: We have operated 18 cases of MRKH syndrome with the Sheares′ method of vaginoplasty, in which the space between the two labia is dilated with a Hegar′s dilator along the vestigial Mullerian ducts. Thus, two tunnels are created and the central septum is excised to form a single vagina. A mould covered with amnion is placed in the neovagina. All cases are followed up for six months. They have all had a good length of vagina with regular manual dilatation. Conclusions: The Sheares′ method of vaginoplasty is an easy and safe method to create a neovagina with least complications, like injury to urinary bladder, rectum or bleeding.