ABSTRACT
Abstract The kidneys and ureters are retroperitoneal structures in the upper part of the paravertebral gutters, tilted against the structures on the sides of the lowest two thoracic and upper three lumbar vertebrae, so that their anterior and posterior surfaces face antero-laterally and postero-medially, respectively. Congenital anomalies of the urinary tract are often the underlying cause of renal pathologies; 40% of these pathological conditions are due to variations in location, shape, and size of the kidney(s), calyces, ureter, or bladder. This case report describes the presence of a unilateral non-rotated left kidney with vascular and ureter variations found during routine cadaveric dissection for medical graduates. Alterations in rotation of the kidney and its relation to structures at the hilum have great clinical significance when conducting surgical procedures like partial nephrectomy, nephron sparing surgery, and renal transplantation.
Resumo Os rins e o ureter são estruturas retroperitoneais localizadas na parte superior do sulco paravertebral, inclinados contra as estruturas laterais das duas vértebras torácicas inferiores e das três vértebras lombares superiores. Assim, as superfícies anteriores e posteriores estão nas porções anterolateral e posteromedial, respectivamente. As anomalias congênitas do trato urinário frequentemente são causas subjacentes de patologias renais, e 40% delas ocorrem devido a variações no local, formato e tamanho dos rins, cálices, ureter ou bexiga. Este relato de caso descreve a presença de rim esquerdo unilateral sem rotação com variações vasculares e de ureter encontradas durante uma dissecção de cadáver rotineira com graduandos de Medicina. As alterações na rotação do rim e a sua relação com as estruturas no hilo têm grande importância clínica durante procedimentos cirúrgicos como a nefrectomia parcial, a cirurgia poupadora de néfrons e o transplante renal.
Subject(s)
Humans , Male , Aged, 80 and over , Congenital Abnormalities , Kidney/abnormalities , Torsion Abnormality , Urinary Tract/abnormalities , Nonagenarians , NephrectomyABSTRACT
Two cases of non-rotation of the midgut were detected in cadaveric bodies from the Department of Anatomy, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand. They were both female, aged 83 and 32, respectively. In both cases, the duodenum, jejunum, ileum, and colon lay in the unrotated position with the small intestine occupying the right half and the large intestine occupying the left half of the abdominal cavity. Additionally, the duodenojejunal junction remained on the right side of the abdomen, whereas the caecum and ascending colon lay in the midline, with the terminal ileum entering the right side of the caecum. The appendix entered the left side of the caecum. Interestingly, they had had no clinical symptoms during life. These abnormalities implied that midgut rotation during embryonic period occurred only as far as 90-degrees counterclockwise instead of the usual 270-degree rotation. To our knowledge, this is the first report of asymptomatic non-rotation of the midgut in Thailand. The variation found in the present study provides additional information concerning the variation seen in human anatomy and should be considered in patients with atypical symptoms related to the gastro-intestinal tract.
ABSTRACT
The most common developmental anomaly of midgut rotation and fixation is non-rotation. Symptomatic intestinal malrotation is relatively common in infants and children but uncommon in later ages. Most adult cases are silent throughout life and are not discovered unless they cause acute or chronic abdominal pain. Many such patients have ill-defined abdominal complaints and are labeled as having a "functional" disorder since no definite clinical abnormalities are found other than the subjective complaints. The most frequent symptomatic presentation in the adult is midgut volvulus the symptom of which is usually self-limited although often recurrent and sometimes leading to an abdominal catastrophe. The diagnostic means for the adulthood malrotation include simple and contrast radiographic studies and CT scan. Malrotation first detected by cholescintigraphy is rare. We report a case of intestinal non-rotation incidentally discovered on DISIDA hepatobiliary scintiscan.