Nadeem Akhtar, Ilyas Bader.
Iliac Kidney Mimicking an Appendicular Mass.
J Surg Jan ;23-24:55-6.

Ectopic Kidneys continue to hose diagnostic dilemma to the surgeons. There ectopic position within the body at times render them difficult to differentiate from other common neoplaslic and cystic masses. We are reporting a case of iliac kidney, which presented as a tender mass in the right iliac fossa.

A 9 years old girl presented with the history of abdominal pain, fever and vomiting for one day. Pain was intense and localized in the right iliac fossa. This pain was non-radiating, and increased with movements and standing and with no relieving factors. Fever was intermittent, high grade. Patient had 3 to 4 episodes of nonprojectile vomiting which was non bilious. There were no urinary complaints. On examination the patient was looking toxic with mild dehydration and had a temperature of 101oF. On abdominal examination there was tenderness, rebound tenderness and guarding in the right iliac fossa. A small mass measuring 3x3cm was palpable in the right iliac fossa. This was mobile in both the transverse and longitudinal axis. It was firm in consistency. Bowel sounds were sluggish. Per rectal examination and examination of other systems were unremarkable. On investigations her total leukocyte count was 24300 /cmm, USG showed multiple gas filled adynamic fluid filled gut loops thus making it difficult to see other viscera. There was free fluid seen in between the intestinal loops. Initial diagnosis was of that of an appedicular mass. On bimanual examination it was observed that the mass was mobile and non-tender. Exploration was done through a lance incision. Appendix was grossly inflamed and there was a retro peritoneal mass which on further exploration turned out to be an iliac kidney attaining its blood supply from right common iliac artery and the renal vein was draining into the right common iliac vein. Appendectomy was done. Postoperatively child had an uneventful recovery. In the post operative period child was evaluated by doing and IVU and ultrasound was repeated. These invest igations showed a low-lying iliac kidney on the right side with normally placed kidney on the left side of the abdomen.

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