Crossed fused renal ectopia with herniation into the scrotum: A cadaveric case report

Abstract

Background: Congenital kidney anomalies, such as horseshoe kidney and unilateral renal agenesis, are rare, occurring in 0.2% and 0.1% of live births, respectively. Vesicoureteral reflux, affecting 1-3% of children, is more common and often associated with recurrent urinary tract infections.

Methods: During routine dissection of a whole-body donor, a rare case of a right-sided renal ectopia with suspected scrotal herniation was observed. The donor, a 108-year-old white male with a history of arrhythmia, lacked a left kidney with no evidence of nephrectomy.

Results: The remaining kidney was ectopically located in the right iliac fossa, with its inferior pole terminating at the inguinal ligament. The parenchyma was embedded superiorly within the psoas major muscle and extended inferiorly into the scrotal sac. Fascial attachments to perinephric fat were observed, with the fat herniating into the scrotum. Within the scrotum, the perinephric fat and its fascial connections were fused with the right testicle, which had an elongated vas deferens. The kidney appeared to be fused, with evidence of a shared blood supply and ureter configuration consistent with a crossed fused renal ectopia.

Conclusion: This study identifies a unique case of a pelvic kidney with perinephric fat herniation into the scrotum, immobilizing the kidney. It highlights the complex interplay between urinary and reproductive anatomy and underscores the importance of recognizing such variations. These can impact renal function, fertility and surgical outcomes. Greater awareness of these anomalies can improve diagnostic accuracy and inform clinical decision making.