Title: Ureteric Fusion – An Unusual Presentation of Crossed Fused Renal Ectopia
Authors: Shivi Jain, Prashant Nath Gupta, Abhishek Mane, Ashish Verma, Ram C Shukala, Arvind Srivastava
DOI: http://dx.doi.org/10.18535/jmscr/v3i9.54
Abstract
Background: Crossed fused renal ectopia is a rare congenital anomaly where the kidneys are fused and located on the same side of the midline. The ureter of the ectopic kidney crosses the midline and enters the urinary bladder on the opposite side. The purpose of this case report is to show the rare but important variation of this anomaly and to highlight its embryological and clinical significance.
Case: A 58-year-old female presented with upper abdominal pain. CECT abdomen showed choledocholithiasis with an incidental presence of right-sided crossed fused renal ectopia with ureteric fusion.
Conclusion: Careful assessment of an incidental finding on imaging is also very important for overall prognosis besides searching for the actual etiology behind the clinical manifestations. Any congenital anomaly or normal variant is important to document. This prepares both the patient and the treating clinician for any future endeavour/eventuality.
Keywords: renal ectopia; crossed fused renal ectopia; ureteric fusion
References
1. Congenital anomalies. In: Dunnick NR, Sandler CM, Newhouse JH, Amis ES, editors. Textbook of Uroradiology. 4th ed . Philadelphia : Lippincott Williams & Wilkins, 2007; p 14-41.
2. Shapiro E, Bauer SB, Chow JS. Anomalies of the Upper Urinary Tract. In: Wein AJ, Kavoussi LR, Novick AC, Partin AW, Peters CA, eds. Campbell-Walsh Urology. 10th ed. Philadelphia: Saunders-Elsevier, 2011; p 3123-60.
3. Patel TV, Singh AK. Crossed fused ectopia of the kidneys. Kidney Int. 2008;73:662.
4. Meyers MA, Whalen JP, Evans JA, Viamonte M. Malposition and displacement of the bowel in renal agenesis and ectopia: New observations. Am J Roentgenol Radium Ther Nucl Med. 1973; 117:323–33.
5. Differential Diagnosis of Urogenital Disorders. In: Dähnert W, editor. Radiology Review Manual. 7th ed. Philadelphia, Baltimore: Lippincott Williams and Wilkins, 2011; p 902.
6. Kaur N, Saha S, Mriglani R, Saini P, Gupta A. Crossed Fused Renal Ectopia with a Single Ureter: A Rare Anomaly. Saudi J Kidney Dis Transpl 2013; 24(4):773-6.
7. Cook WA, Stephens FD. Fused kidneys: Morphologic study and theory of embryogenesis. Birth Defects Orig Artic Ser 1977; 13:327-40.
8. Marshall FF, Freedman MT. Crossed renal ectopia. J Urol 1978; 119:188-91.
9. Boyan N, Kubat H, Uzum A. Crossed renal ectopia with fusion: Report of two patients. Clin Anat 2007; 20:699-702.
10. Gur U, Yossepowitch O, Baniel J. Transitional cell carcinoma in a fused crossed ectopic kidney. Urology 2003; 62:748.
11. Davis CM, Rao MV, Flanigan RC, Quek ML. Renal cell carcinoma in two patients with crossed fused ectopic kidneys. Urol Int 2008; 81:370-2.
12. Redman JF, Berry DL. Wilms’ tumor in crossed fused renal ectopia. J Pediatr Surg 1977; 12:601-3.