Large stone in crossed unfused ectopic kidney with totally intrarenal pelvis.

To cite: Prakash J, Swami V, Singh BP, et al. BMJ Case Rep Published online: [please include Day Month Year] doi:10.1136/ bcr-2013-200713 DESCRIPTION A 35-year-old man with no significant medical history presented with an 8-month history of dull pain in his right-lower abdomen. There was no relevant family history. Intravenous urography (IVU) was performed in a peripheral hospital (figure 1A–C) and showed a normal right kidney and an ectopic left kidney (at the L4-L5 level right to midline) with a 25 mm pelvic stone. We further performed CT urogram for complete anatomical details (figure 1D, E) and found a left-crossed renal ectopia (RE) with pelvic calculi and good contrast uptake and excretion by both kidneys, left ureter not excreted due to stone. Retrograde ureteropyelogram (figure 2A–C) delineated a normal calibre of the left ureter which crossed from the left to right side. In view of large stone burden, we opted for laparoscopic pyelolithotomy (figure 3A). Intraoperatively, there was a totally intrarenal pelvis and we found difficulty in progression (figure 3B), so the procedure was converted to open surgery and the stone was removed by extended pyelolithotomy (figure 3C). RE is an unusual condition. Birmole et al mentioned that crossed RE was first described by Pannorlus in 1654. It is a very uncommon condition and more than 90% are fused. Its coexistence with nephrolithiasis is even rarer. Nephrolithiasis in crossed unfused RE with totally intrarenal pelvis have not been reported to the best of our knowledge. CT urography is the gold standard for stones in normal as well as in anomalous renal excretory systems and IVU should not be performed.