Presentation
Abdominal pain for investigation on the background of hypertrophic obstructive cardiomyopathy (HOCM).
Patient Data
single-lead pacemaker in situ
no cause for the patient's abdominal pain was identified
incidental finding of an anterolaterally facing malrotated duplex left kidney with a duplex collecting system draining into a single ureter
two left renal arteries, with the inferior artery arising from the left common iliac artery and passing posterior to the kidney
three left renal veins, one passing anterior to the aorta and draining into the right IVC, one joining a left ascending lumbar vein and passing retroaortic into the IVC, and one passing posterior to the kidney to drain into the left common iliac vein
two right renal arteries and two right renal veins
Case Discussion
In this case, the duplex collecting system unites into a single ureter at the pelviureteric junction (PUJ), but a duplex collecting system may have two ureters that unite before the vesicoureteric junction (VUJ), called the bifid ureter, or complete duplication, called the double ureter.
The renal malrotation, in this case, would be classified as incomplete, with the hilum and pelvis facing anterolaterally. This is the most common type of renal malrotation, but the renal hilum may face posteriorly (excessive rotation) or further laterally (reversed rotation).
The case findings were a collective effort, with thanks to Dr. Alex Jarema and Dr. George Harisis.
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