CASE PRESENTATION
A 61-year-old man presented to the Emergency Department with vomiting and progressively worsening abdominal pain. A computed tomography (CT) was performed. The diagnosis of patient was acute cholecystitis and the patient was referred to general surgery clinic. In addition CT scan showed bilateral ectopic kidneys with urinary bladder herniation (Figures 1 and 2). Both kidneys were fused at the medial borders of each pole. To our knowledge, the case of pancake kidney with bladder herniation was not published yet in the literature.
Pancake kidney is very rare type of congenital fusion anomaly of the kidney. It is described as a renal mass located in the pelvis which is formed by complete medial fusion of renal parenchyma without intervening septum (11. Tiwari AK, Choudhary AK, Khowal H, Chaudhary P, Arora MP. Pancake kidney: A rare developmental anomaly. Can Urol Assoc J. 2014;8:E451–2.). Each kidney has its own collecting system and anteriorly placed short ureters entering the bladder orthotopically (11. Tiwari AK, Choudhary AK, Khowal H, Chaudhary P, Arora MP. Pancake kidney: A rare developmental anomaly. Can Urol Assoc J. 2014;8:E451–2.). The presence of a pancake kidney may predispose the formation of stones due to the probable rotation anomaly of the collecting system and short ureters which are prone to stasis and obstruction. Patients with pancake kidney are usually asymptomatic, but may present with features of urinary tract infection, fever and vague lower abdominal pain (11. Tiwari AK, Choudhary AK, Khowal H, Chaudhary P, Arora MP. Pancake kidney: A rare developmental anomaly. Can Urol Assoc J. 2014;8:E451–2.). If a pancake kidney has to undergo surgery, division of the parenchyma presents potential problems such as renal vascular damage, postoperative renal failure and eventual renal failure (22. Eze AR, White JV, Pathak AS, Grabowski MW. “Pancake kidney”: a renal anomaly complicating aortic reconstruction. Ann Vasc Surg. 1998;12:278–81.). Asymptomatic cases can be managed conservatively with long-term follow-up of renal function (11. Tiwari AK, Choudhary AK, Khowal H, Chaudhary P, Arora MP. Pancake kidney: A rare developmental anomaly. Can Urol Assoc J. 2014;8:E451–2.). If there are symptoms of renal failure, surgery is warranted. Ultrasonography, excretory urography and CT were efficient in detection and evaluation of pancake kidney anomaly (11. Tiwari AK, Choudhary AK, Khowal H, Chaudhary P, Arora MP. Pancake kidney: A rare developmental anomaly. Can Urol Assoc J. 2014;8:E451–2.).
REFERENCES
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1Tiwari AK, Choudhary AK, Khowal H, Chaudhary P, Arora MP. Pancake kidney: A rare developmental anomaly. Can Urol Assoc J. 2014;8:E451–2.
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2Eze AR, White JV, Pathak AS, Grabowski MW. “Pancake kidney”: a renal anomaly complicating aortic reconstruction. Ann Vasc Surg. 1998;12:278–81.
Publication Dates
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Publication in this collection
Nov-Dec 2015
History
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Received
16 Dec 2014 -
Accepted
04 Sept 2015