Ectopic pelvic kidney associated with uretero-pelvic junction obstruction: a case report

Ectopic kidneys though uncommon can be associated with other anomalies of the genitourinary system such as uretero-pelvic junction obstruction, vesicoureteral reflux and upper urinary tract abnormalities. These associations present surgical challenges in an ectopic kidney. We report the surgical management of a right ectopic kidney associated with uretero-pelvic junction obstruction and severe hydronephrosis. A 27-year-old male presented to Zenith Medical and Kidney Center in Abuja with complaints of recurrent, dull right flank pain of 1 year duration. Physical examination revealed a non-tender cystic mass extending from the right iliac fossa to the right hypochondrium. Abdominopelvic computed tomography revealed huge intraperitoneal non-enhancing hypodense ovoid cystic mass difficult to differentiate from the right ureter with severe intraperitoneal mass effect. Retrograde pyelogram done revealed right ectopic pelvic kidney with uretero-pelvic junction obstruction. The patient subsequently had right open Anderson-Hynes pyeloplasty. Intraoperative findings were right ectopic pelvic kidney with uretero-pelvic junction obstruction secondary to intrinsic narrowing at the junction and severe hydronephrosis. Posto­perative recovery was uneventful with complete resolution of the presenting symptom. Ectopic kidneys can be associated with uretero-pelvic junction obstruction which presents diagnostic and surgical treatment challenges. Retrograde pyelography is an important radiological armamentarium for the proper diagnosis and subsequent treatment of this condition.