A Case of Left Retroexternal Iliac Artery Megaureter Associated with Additional Renal and Vascular Congenital Anomalies

Abstract

Introduction. A number of rare anatomical anomalies, including retroexternal iliac ureter, extrarenal calyces (ERCs), and vascular anomalies, were observed in a 96-year-old female cadaver during a routine dissection. Description. A markedly dilated left extrarenal pelvis (ERP) with a diameter of 3.15 cm was noticed. Three major calyces were found outside of the normal-sized left kidney. The abdominal aorta (AA), instead of normal bifurcation, branched to the right common, left external, and left internal iliac arteries. The median sacral artery was a direct branch from the right common iliac artery. No hydronephrosis was observed on the affected side, and no urinary tract anomalies were observed on the right side. Significance. The retroiliac megaureter is a rare congenital anomaly, with fewer than 25 cases reported to date. Additionally, the ERCs are amongst the rarest anomalies of the renal collecting system. Further, the current case is one of few reported cases where the particular branching pattern of the AA was observed. The combination of such anatomical anomalies is rare, and the relationship between them is unclear. Common clinical manifestations of retroiliac ureters are the results of ureteric obstruction, hydronephrosis, and secondary infection. Precise knowledge of anomalies of the kidney and urinary tract can help radiologists and surgeons make a definitive diagnosis and prevent inadvertent injury during surgery.

Trisomy 13 with retroiliac ureter diagnosed by assessment for recurrent febrile urinary tract infections

“…The retroiliac ureter, first described in 1960, 12 is often asymptomatic or associated with other genitourinary malformations, secondary to vascular malformations similar to the retrocaval ureter 13,14 . Surgical treatment generally involves transecting the ureters on the dorsal side of the intersecting iliac arteries and performing ureteroureteral anastomosis on the ventral side 15 . Congenital mid‐ureteral stricture is rare, and renal ultrasound alone is not reliable for demonstrating the site of obstruction 7 .…”

“…13 , 14 Surgical treatment generally involves transecting the ureters on the dorsal side of the intersecting iliac arteries and performing ureteroureteral anastomosis on the ventral side. 15 Congenital mid‐ureteral stricture is rare, and renal ultrasound alone is not reliable for demonstrating the site of obstruction. 7 Retrograde pyelography performed during the surgical procedure is crucial for identifying the narrowing site in the affected ureteral segment.…”