PMC8711840_01
CT with Axial (A and B), Coronal (C), and Sagittal (D) views show two left fused kidneys with dilated PCS and multiple renal stones. The native kidney is located cranially and facing anteromedially (A). The caudally placed supernumerary kidney is malrotated, facing anterolaterally (B) as shown by arrows.
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He further underwent computed tomography urography (CTU), which showed two fused left kidneys and a single right kidney (Figure 1A-D). The PCS (pelvicalyceal system) of the upper kidney was located anteromedially (Figure 1A) and that of the lower kidney was malrotated, facing anterolaterally (Figure 1B).
CT shows two left renal arteries (superior- red arrow, inferior- black arrow) and single right renal artery arising from the aorta (A), and two left renal veins (superior- green arrow, inferior- yellow arrow) forming a common trunk before joining IVC (B). A 3D reconstruction shows left multiple renal stones (C), and separately draining calyceal systems with a common renal pelvis and single ureter on excretory phase as shown by the yellow circle (D).
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There are two separate renal arteries (both arise from the aorta) and renal veins (Figure 2A and B). Multiple calyceal stones of varying sizes were seen in both left kidneys and one big obstructing stone (4cm x 2.2cm) in the common renal pelvis (Figure 2C). The left fused kidneys had a separately draining calyceal system with a common extrarenal left pelvis and a single ureter (Figure 2D).
Intra-operative pictures (A-C). Fused left kidneys (relatively small caudally located SNK and normally placed NK) with single renal pelvis and ureter (A). Left pyelotomy site with access to both kidneys (dashed circle) (B). Multiple extracted renal stones (C).
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There was a dilated renal pelvis with a palpable big stone inside (Figure 3A). So, we were able to access both kidneys through the common renal pelvis, and most of the stones were extracted (Figure 3B). A total of 13 stones were removed (Figure 3C), and a Double-J stent was placed.
Postoperative X-ray shows a 1.5 x 1cm radio-opaque structure at the level of L4 and Double-J stent on the left side.
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Postoperative control X-ray showed 1.5cm x 1cm residual stone (Figure 4).