Ectopic left renal artery originating from the left common iliac artery: a rare anatomic variation

Abstract

CASE PRESENTATION We present the case of a rare anatomic variation observed during a laparotomy procedure for endometrial cancer of mixed endometrioidserous type. It consists of an ectopic left renal artery originating directly from the left common iliac artery just below the level of aortic bifurcation in a 56yearold patient with an ectopic pelvic kidney. The ectopic pelvic kidney was found in the retroperitoneal space, approximately at the level of sigmoid reflection. The left renal artery originated just 2 cm below the level of bifurcation, while the left renal vein drained from the left iliac vein, also 2–3 cm below the level of vena cava bifurcation, having a parallel route just below the left renal artery (Figure 1). The pelvic location of the left kidney was established preoperatively by CT and was remarked on by radiologists as it is a rare anatomic variation, occurring in one in 3000 patients. Surgical preparation during paraaortic lymphadenectomy was challenging as the ectopic location of the kidney as well as the described anatomic variation caused alterations in the standard surgical approach of typical paraaortic lymphadenectomy. Appropriate preoperative evaluation of potential anatomic variations based on imaging findings may help avoid intraoperative complications.