Direct Intestinal Effects Unique to Renal Ectopia

Ectopic kidneys may be located in the true pelvis (63%), in the iliac fossa or opposite the crest of the ilium (8%), or in the abdomen below the level of the second or third lumbar vertebra and above the crest of the ilium (29%).24 In cases of ectopic kidney in the true pelvis, there is usually no definite pressure effect upon the sigmoid colon, presumably because the kidney within the sacral hollow does not come into relationship with the anteriorly directed sigmoid loops.16

However, renal ectopia in the iliac fossa or lower abdomen may result in a characteristic mass effect on or displacement of the ascending or descending colon.16

On plain films or barium contrast studies, the contour of the density that may be seen in ectopic kidneys usu

Bowel And Spleen

Fig. 9—60. Malposition of the bowel and pancreas following left nephrectomy.

(a) CT scan at level of the spleen shows the tail of the pancreas (P) sharply deviated into the renal bed. (Incidentally noted is a right adrenal cyst.)

(b and c) At lower levels opacified jejunal loops and feces-containing colon occupy the "empty" renal fossa.

Fig. 9—60. Malposition of the bowel and pancreas following left nephrectomy.

(a) CT scan at level of the spleen shows the tail of the pancreas (P) sharply deviated into the renal bed. (Incidentally noted is a right adrenal cyst.)

(b and c) At lower levels opacified jejunal loops and feces-containing colon occupy the "empty" renal fossa.

ally is not clearly outlined. Two factors appear to account for this: (a) the relative lack of contrasting extraperitoneal fat in the lower abdomen and upper pelvis, and (b) the common marked anterior malrotation of the ectopic kidney. The latter feature also brings the ectopic kidney in the iliac or lower abdominal area into close relationship with the medial borders of the ascending and descending colon and small bowel loops (Fig. 964). Failure to recognize the characteristic mass effects and displacements as secondary to renal ectopia may lead to unnecessary surgery.

If displacement of small bowel loops toward the mid-line can also be demonstrated, the reniform contour of the "mass" may be shown more clearly (Fig. 9-65).

Kidney Malrotation

Fig. 9—61. Malposition of the bowel and pancreas following left nephrectomy, demonstrated by computed tomography.

(a and b) The splenic flexure of the colon (C), opacified by contrast medium, and the tail of the pancreas (P) are deviated into the renal bed.

Fig. 9—61. Malposition of the bowel and pancreas following left nephrectomy, demonstrated by computed tomography.

(a and b) The splenic flexure of the colon (C), opacified by contrast medium, and the tail of the pancreas (P) are deviated into the renal bed.

Right Renal Bed

Fig. 9-62. Malposition of the bowel following right nephrectomy.

The hepatic flexure of the colon (C) and the descending duodenum (D), accompanied by the head of the pancreas, occupy the "empty" renal fossa on the right.

Fig. 9-62. Malposition of the bowel following right nephrectomy.

The hepatic flexure of the colon (C) and the descending duodenum (D), accompanied by the head of the pancreas, occupy the "empty" renal fossa on the right.

Fig. 9-63. Herniation of the colon following right nephrectomy.

CT demonstrates incisional herniation of the posterior hepatic flexure into the flank.

Fig. 9-63. Herniation of the colon following right nephrectomy.

CT demonstrates incisional herniation of the posterior hepatic flexure into the flank.

Hepatic HerniationLeft Lower Quadrant Mass

Fig. 9-64. Ectopic kidney in a 24-year-old female with left lower quadrant mass.

(a) Barium enema examination demonstrates extrinsic mass impression on medial aspect of lower descending colon. In addition, the splenic flexure is sharply angulated posteromedially, indicating an empty renal fossa.

(b) Intravenous urogram documents a left ectopic kidney with marked anterior malrotation in relationship laterally to the descending colon.

(Reproduced from Meyers et al.16)

Fig. 9-64. Ectopic kidney in a 24-year-old female with left lower quadrant mass.

(a) Barium enema examination demonstrates extrinsic mass impression on medial aspect of lower descending colon. In addition, the splenic flexure is sharply angulated posteromedially, indicating an empty renal fossa.

(b) Intravenous urogram documents a left ectopic kidney with marked anterior malrotation in relationship laterally to the descending colon.

(Reproduced from Meyers et al.16)

Renal Ectopia

Fig. 9-65. Ectopic kidney.

(a) Small bowel series. Inframesocolic mass displacement of the small bowel and colon in the right lower quadrant. Note reniform contour of mass displacement.

(b) Intravenous urogram reveals an ectopic right kidney with characteristic anterior malrotation. (Reproduced from Meyers et al.16)

Fig. 9-65. Ectopic kidney.

(a) Small bowel series. Inframesocolic mass displacement of the small bowel and colon in the right lower quadrant. Note reniform contour of mass displacement.

(b) Intravenous urogram reveals an ectopic right kidney with characteristic anterior malrotation. (Reproduced from Meyers et al.16)

Essentials of Human Physiology

Essentials of Human Physiology

This ebook provides an introductory explanation of the workings of the human body, with an effort to draw connections between the body systems and explain their interdependencies. A framework for the book is homeostasis and how the body maintains balance within each system. This is intended as a first introduction to physiology for a college-level course.

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