A rare case of advanced CKD with extensive cystic renal disease causing bowel obstruction.

Introduction: Acquired cystic kidney disease (ACKD) occurs in patients with kidney failure, leading to renal cyst formation. Although typically asymptomatic, large cysts can cause unusual complications like gastrointestinal obstruction. Case presentation: An 18-year-old female with stage V chronic kidney disease developed abdominal distension and bowel obstruction caused by a large renal cyst. Imaging confirmed the diagnosis, and conservative management with fluid control, dialysis, and infection management was initiated. Discussion: The presentation of a renal cyst causing bowel obstruction is extremely rare, and the optimal management approach remains unclear. Diagnosis relies on imaging modalities such as ultrasound and CT, which help identify cyst characteristics and associated complications. In such cases, conservative treatment is generally preferred, focusing on symptom management through dietary modifications, while surgical intervention is considered only if symptoms persist despite medical therapy. Conclusion: This case highlights the rare presentation of bowel obstruction due to ACKD and emphasizes the importance of early imaging and a multidisciplinary approach in managing such complications.