Crossed Fused Renal Ectopia, a Rare Case Presenting with Pain Abdomen

Crossed fused renal ectopia essentially refers to an anomaly where the kidneys are fused and located on the same side of the midline. Crossed renal ectopia is a rare congenital anomaly most often silent. More than 90% of crossed renal ectopia is fused. We report a rare case of crossed renal ectopia presenting with pain abdomen unusual. Our patient is a 43-year-old male, previously doing well, presented with acute onset of lower abdominal pain and vomiting and mild tenderness in right iliac fossa. The clinical suspicion was that of an acute appendicitis. Computed tomography was performed with I.V iodinated contrast in early and delayed phase revealed fused crossed renal ectopia. Although crossed renal ectopia is an uncommon cause of acute abdominal pain, there should be an index of clinical suspicion in previously healthy individuals presenting with acute abdominal pain. INTRODUCTION Crossed renal ectopia is rare cause of abdominal pain. Most often are silent so underdiagnosed in many clinical scinario. It should be the cause of abdominal pain after other possible causes have been excluded (Gopaldas and Walden, 2008). Around 20 to 30% of cases are incidentally diagnosed (Hwang et al., 2002). CASES A 43-year-old male presented with acute abdominal pain and vomitting. Mild tenderness was observed in right iliac fossa. This was the first episode of such severe abdominal pain. Based on the clinical examination, a diagnosis of acute appendicitis was suspected. The patient had no significant past medical history non diabetic and BP was 124/76 mm of Hg. Initial blood investigations shows mild leucocytosis. Serum urea and creatinine were normal. Chest X-ray was cleen. Abdominal X-rays reveal non specific bowel gas pattern and an illdefined small radio opacith over sacral shadow. Computed tomography (CT) scan was requested to evaluate for the cause. CT scan was performed in 128 slice CT Scanner, study was performed in three phases that is plain (figure 1), immediate iv (figure2) and delaed phase (figure 3) revealed crossed fused ectopic left to the right kidney inferiorly with lower fused left kidney showing moderate hydroureteronephrosis with a calculus in left proximal ureter .left ureter seen to cross midline with normal insertion to base of bladder in left side (figure 3). Figure 1: Noncontrast ct scan reveal left proximal ureteric calculus with ureteric wall oedema Indian Journal of Medical Case Reports ISSN: 2319–3832(Online) An Online International Journal Available at http://www.cibtech.org/jcr.htm 2013 Vol.2 (4) October-December, pp.30-33/Suvendu and Jayashree