Ectopic kidneys - subdiaphragmatic

Case contributed by Eugen Divjak

Presentation

A lady came to the ER with complaints of nausea, vomiting and diffuse abdominal pain. She states that she underwent abdominal surgery as a child, "it had something to do with bowel". No medical documentation regarding the surgery is available. Ileus was suspected and she was referred for a CT scan.

Patient Data

Age: 35 years
Gender: Female

Signs of ileus are present: small bowel is dilated with gas-fluid levels. The underlying cause can be identified, as transitional zone is seen in the terminal ileum, which shows thickened wall and blurred surrounding fat tissue. Most likely, postoperative fibrous adhesions have caused small bowel obstruction.  Free fluid is seen in the pelvis. Note the intestinal malrotation, with colon predominately within the left hemiabdomen.

Ectopic kidneys can be seen: left between spleen and diaphragm, and right between liver and diaphragm. 

Case Discussion

The patient underwent urgent surgery and bowel obstruction due to adhesions was confirmed.

While the typical presentation of ileus due to postoperative adhesions is presented in this case, a less common case of ectopic kidneys is demonstrated. Subdiaphragmatic ectopic kidneys are an uncommon congenital anomaly, which is found once in 22 cases of ectopic kidneys1,2. It is most often discovered incidentally while being investigated for other pathology. Bowel malrotation is also present.

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Case information

rID: 68406
Published: 7th Jun 2019
Last edited: 7th Jun 2019
Inclusion in quiz mode: Included
Institution: University Hospital Dubrava

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