Concurrent Vascular and Pelvic Anomalies of the Kidney: A Rare Cadaveric Observation.

This case report describes the concurrent occurrence of rare renal vascular and pericalyceal variations and highlights their surgical significance. The renal vasculature and pelvis exhibit a wide spectrum of anatomical variations, many of which are clinically and surgically significant. Awareness of these deviations is of immense importance during retroperitoneal and renal surgeries and interventions. This report presents concurrent variations in both renal arteries and veins, as well as the renal pelvis, observed in a cadaver during routine dissection at the All India Institute of Medical Sciences, Deoghar, Jharkhand, India. Standard retroperitoneal dissection techniques were employed to expose and examine the structures. Observations were based on direct anatomical inspection and morphometric measurements. Variations were noted in the arterial supply, where at least three arteries supplied the right kidney - two arising from the abdominal aorta and one from the right common iliac artery - while two supplied the left kidney, arising from the abdominal aorta. These findings highlighted a deviation from the usual pattern of a single renal artery on each side. Bilateral venous variations were also observed. The left renal vein (LRV) had three tributaries: two venous channels forming the anterior limb and one draining into the inferior vena cava (IVC) as the posterior limb of a circumaortic venous ring. On the right side, three separate venous tributaries arising at different levels from the right kidney entered the IVC, along with an additional independent renal vein from the inferior renal pole draining inferiorly into the IVC. Furthermore, a trifid renal pelvis was found on the right side, characterized by three well-defined infundibula that drained separate calyces, resulting in a trifid configuration. No such variations in the pelvis were noted on the left side. This rare concurrence of venous, arterial, and pelvic variations underscores the importance of meticulous preoperative vascular mapping and radiological evaluation to prevent iatrogenic complications during nephrectomy, renal transplantation, vein catheterization, or other renal and retroperitoneal surgeries.