Pelvi-ureteric obstruction with aberrant accessory lower pole renal artery
Severe left loin pain with background history of loin ache
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Typical congenital PUJ obstruction characterised by a dilated renal pelvis and collapsed ureter. Accessory lower pole renal artery (arrow) arising from the aorta, passing anterior to the junction of the ureter and renal pelvis to enter the lower pole of kidney.
The detection of an aberrant accessory artery is important for 2 reasons. Firstly it may be an aetiological factor in the development of congenital PUJ obstruction. Secondly it is important for the surgeon to be aware of this vessel as it may be compromised at the time of pyeloplasty, especially if performed at laparoscopy.