Rare variant of renal vascularization with bilateral multiple pedicles and incomplete rotation - case report.

Renal blood vessels present great morphological variability. The routine dissection of a 68-year-old male cadaver revealed multiple bilateral vascular variations associated with the incomplete rotation of both kidneys. The left kidney was supplied by three renal arteries: one superior artery and one middle artery with hilum penetration, and one inferior artery with inferior polar penetration. All three arteries arose from the aorta: two from the anterior side at levels L1 and L3, and one - the inferior artery - from the posterior side of the aorta, as a common trunk with the middle sacral artery. The right kidney had two arteries, both arising from the aorta. The superior renal artery, arising at level L1, entered the renal parenchyma at the hilum; the inferior artery, arising at the point where the abdominal aorta branches in the two common iliac arteries, entered the parenchyma at the inferior pole. Each of the five arteries was accompanied by a vein. The (bilateral) superior renal veins and the middle left vein drained into the inferior vena cava. The two inferior renal veins joined to form a common trunk that drained into the left common iliac vein. Both kidneys presented incomplete rotation, each renal pelvis being situated anterior to the renal vessels, and the ureters descending on the anterior sides of the kidneys. The presence of several vascular pedicles may represent a contraindication in laparoscopic nephrectomy or cause severe bleeding if the pedicles are injured during endopyelotomy.