Advances in surgical and uro-radiological techniques dictate a reappraisal and definition of renal arterial variations. This retrospective study aimed at establishing the incidence of additional renal arteries. Two subsets were analysed viz.: a) Clinical series--130 renal angiograms performed on renal transplant donors, 32 cadaver kidneys used in renal transplantation b) Cadaveric series--74 en-bloc morphologically normal kidney pairs. The sex and race distribution was: males 140, females 96; African 84, Indian 91, White 43 and "Coloured" 18, respectively. Incidence of first and second additional arteries were respectively, 23.2% (R: 18.6%; L: 27.6%) and 4.5% (R: 4.7%; L: 4.4%). Additional arteries occurred more frequently on the left (L: 32.0%; R: 23.3%). The incidence bilaterally was 10.2% (first additional arteries, only). The sex and race incidence (first and second additional) was: males, 28.0%, 5.1%; females, 16.4%, 3.8% and African 31.1%, 5.4%; Indian 13.5%, 4.5%; White 30.9%, 4.4% and "Coloured" 18.5%, 0%; respectively. Significant differences in the incidence of first additional arteries were noted between sex and race. The morphometry of additional renal arteries were lengths (cm) of first and second additional renal arteries: 4.5 and 3.8 (right), 4.9 and 3.7 (left); diameters: 0.4 and 0.3 (right), 0.3 and 0.3 (left). Detailed morphometry of sex and race were also recorded. No statistically significant differences were noted. Our results of the incidence of additional renal arteries of 27.7% compared favourably to that reported in the literature (weighted mean 28.1%). The study is unique in recording detailed morphometry of these vessels. Careful techniques in the identification of this anatomical variation is important since it impacts on renal transplantation surgery, vascular operations for renal artery stenosis, reno-vascular hypertension, Takayasu's disease, renal trauma and uro-radiological procedures.

(Table II).Haematological investigations (n= 145) showed a mean haemoglobin concentration of 11 g/dl (range 6-15 g/dl), a mean total white cell count of

The highly complex embryological development of the left renal vein compared to its right counterpart results in greater variations which are clinically significant. The study aimed to identify these variations and to document its incidence. Cadaveric study: 153 kidney pairs were harvested en bloc, dissected, 100 resin casts prepared and 53 plastinated; renal venography performed on further 58 adults and 20 foetal cadavers. Clinical study: (retrospective analysis): a) radiological study, 104 renal venograms; b) live related renal transplantation, 148 donor left kidneys; c) abdominal aortic aneurysm surgery, 525 patients. Total sample size: 1008. Renal collars observed in 0.3%; retro-aortic vein 0.5%; additional veins 0.4%; posterior primary tributary 23.2%, (16.7% Type IB; 6.5% Type IIB, cadaveric series, only). Our results differ significantly in incidence to that reported in the literature: renal collar 0.2-30%; retro-aortic vein 0.8-7.1%; additional renal vein 0.8-6%. Variations are clinically silent and remain unnoticed until discovered during venography, operation or autopsy. To a transplant surgeon, morphology acquires special significance, since variations influence technical feasibility of operation. Prior knowledge of circum-aortic vein is important when blood samples from suprarenal or renal veins are collected. Collar may provide developed collateral pathway immediately after surgery if renal interruption planned without awareness of its presence. Variations restrict availability of vein for mobilisation procedures. In aortic aneurysm repair, retro-aortic vein is important. During retroperitoneal surgery, the surgeon may visualise a pre-aortic vein but be unaware of an additional retroaortic component or a posterior primary tributary, and may avulse it while mobilising the kidney or clamping the aorta.

Sepsis, in all its forms, is an important cause of morbidity and mortality and requires aggressive treatment. Definitive surgical closure of the fistula should only be performed when the patient is apyrexial and in good nutritional status, and if the fistula effluent shows no signs of decreasing in volume after 4-6 weeks of nutritional support. All reviews of patients with enterocutaneous fistulae reveal that the best results with the least morbidity are obtained by definitive resection and end-to-end anastomoses.

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