Abdominal aortic aneurysm and congenital pelvic kidney.

A 67-year-old man was diagnosed with an abdominal aortic aneurysm (AAA) during routine abdominal ultrasound examination. Computed tomography (CT) showed an infrarenal AAA 6.2 cm in diameter and a pelvic left kidney being irrigated by a single renal artery that emerged from the aortic bifurcation (A). Both kidneys were normal size, with normal arterial and late-phase filling. Arteriography confirmed the CT findings. The patient had no symptoms, and his serum creatinine concentration was normal. The patient gave consent for the publication of his case.

Case report

The patient underwent an elective transperitoneal open repair. After dissection of the proximal aortic neck, both common iliac arteries and the left ectopic renal artery were also dissected and controlled with vessel loops (B). After systemic heparinization and aortic cross-clamping, the aneurysm was opened; a 20- × 10-mm bifurcated Dacron graft was anastomosed proximally to the aortic infrarenal neck, and its right limb was anastomosed directly to the ectopic renal artery (30 minutes of normothermic ischemia). Subsequently, the left limb of the graft was anastomosed to the left common iliac artery. Last, a 10-mm straight Dacron graft was sewn onto the main body of the bifurcated graft (with partial clamping) and anastomosed to the right common iliac artery (C). Systemic intravenous administration of mannitol (0.5 g/kg) 30 minutes before aortic cross-clamping was the only renal protective measure used. The patient was discharged from the intensive care unit after 48 hours, and on postoperative day 7, he underwent CT examination that confirmed patency of the anastomoses and showed that both kidneys had symmetric arterial filling (D). The patient was discharged home on postoperative day 9, maintaining a normal serum creatinine concentration.

Discussion

The incidence of pelvic kidney is 1 of 2100 to 3000 births in the population; its association with AAA is exceedingly rare. The main challenge to repair of this condition is to minimize the ischemic injury to the ectopic kidney. Because this patient had a single artery supplying the ectopic kidney and a normal topic right kidney, we opted not to use any adjunct complex renal preservation technique, keeping the surgical procedure less complex.