Two patients with horseshoe kidney and ruptured abdominal aortic aneurysm

Renal anomalies present a challenge to surgeons who repair aortic aneurysms; horseshoe kidneys occur in 1 out of 400 people in the general population. The degree of fusion, accessory blood supply and ureteric anomalies all affect the approach to aneurysm repair in the elective or emergency setting. The authors report two patients with ruptured abdominal aortic aneurysms, who were found at operation to have a horseshoe kidney. In both cases a thick renal isthmus was found crossing the aorta between the inferior mesenteric artery and the bifurcation. The kidney was preserved intact, accessory blood supply was controlled from inside the aorta and the aneurysm was repaired with a Dacron graft. One patient underwent ureterolysis; although renal failure subsequently developed, it was likely related to prolonged preoperative hypotension. The other patient recovered without complications.