Pyelonephritis of an ectopic right kidney pretending as acute appendicitis: An unusual case

Acute appendicitis is a common condition presenting in emergency department. A patient presenting with pain associated with fever, and tenderness in the right iliac fossa will be suspected to have Acute Appendicitis. However a variety of other clinical conditions may have similar features and may be required to be excluded. Acute pyelonephritis in an ectopic right kidney is a rare clinical condition which may mimic Acute Appendicitis.

We present a middle-age male with complaints of pain in the right lower quadrant of the abdomen with high grade fever for one week. Clinical suspicion and initial ultrasonography (USG) of abdomen supported the diagnosis of acute appendicitis. The patient was initially managed conservatively and later non-contrast computed tomography (NCCT) scan was done that revealed right ectopic kidney with acute pyelonephritis. The appendix was within normal limits on NCCT scan.

Ectopic kidneys result from anomalies of ascend which can result in several complications depending upon its position. Acute appendicitis can also cause pyuria and may mimic urosepsis amounting to its close anatomical proximity to urinary bladder. An un-ascended ectopic kidney with pyelonephritis mimicking acute appendicitis is a rare occurrence. USG and CT scan are important tools in the differential diagnosis but however, USG is greatly operator dependent; CT scan provides excellent diagnostic accuracy.

This case report signifies importance of NCCT abdomen in accurate diagnosis of conditions featuring as right lower abdominal pain and fever. Also emphasizing significance of NCCT prior to any surgical intervention, if any conflict of diagnosis occurs.