Double trouble: pelvi-ureteric junction obstruction and renal cell carcinoma in right to left crossed fused ectopia.

Crossed renal ectopia is a rare occurrence. The majority of the crossed units are fused to their ipsilateral mate. Pelvi-ureteric junction obstruction (PUJO) in crossed fused moieties has been reported very rarely. Similarly, malignancy arising in the crossed over moieties is a rare occurrence too. Only a few cases have been reported earlier. We are here reporting an unusual case with coexistent PUJO and renal cell carcinoma in the crossed over moiety of right to left crossed fused ectopia. To the best of our knowledge, this is the first reported case with both these pathologies, coexisting, in the crossed over moiety. The patient underwent open radical nephrectomy of the right moiety via a lower midline incision. Surgery in this scenario is very challenging due to complex anatomy with aberrant vasculature, which needs for dissection within the renal parenchyma, similar to nephron-sparing surgery to separate from the normal moiety.