We present the clinical case of a 39 year old male that presented with a violent death in the city of Medellin. During the necropsy, a horseshoe Kidney was found, which was never diagnosed according to the patients' medical history. It is a case relevant in the medical field given the unusual vasculature that was found, because it's not a usual arrangement. The lack of symptoms and its spontaneous finding during the necropsy, shows us that it's not a rare find in our environment and that it has a big impact in the surgical fields, and in occasions, with urinary tract infections.Methodology: Descriptive. Informed consent was given by the deceased relatives for the use and analysis of the medical history.Key words: Anatomic variant; horseshoe kidney; renal; kidney; renal blood flow; renal function; anastomosis. IntroductionHorseshoe kidney is an anatomical anomaly that occurs in approximately one of every 400-600 cases, mainly in men.

1. Embriologia Del Sistema Reproductor Pdf

It is the most common fusion anomaly, although it is relatively infrequent. The main complications are related to the severity of renal fusion, such as hydronephrosis, infections, lithiasis, abdominal pain, and, in some cases, abdominal masses. The greatest challenge posed by this anatomical variation is in the surgical field, given its multiple morphological and vascular forms. Description of the clinical caseA cadaver of an unidentified man between 40-45 years of age was received for necropsy.

He was subsequently and reliably identified as 39-year-old DRP.Upon external examination, we found a groomed, medium build, properly dressed man; his shirt had blood on the front and back. Normal anatomy of the kidneyThe kidneys are approximately 10 cm long, 5 cm wide, and 2.5 cm thick. They are located retroperitoneally in the posterior wall of the abdomen, one on each side of the vertebral column, at the level of the T12-L3 vertebrae. Superiorly, the posterior sides of the kidneys are related to the diaphragm, which separates them from the pleural cavities and the twelfth pair of ribs.The superomedial side of each kidney is in contact with an adrenal gland, which acts as part of the endocrine system. The upper urinary organs (kidneys and ureters), their vessels and the adrenal glands are retroperitoneal structures. The renal hilum is at the concave medial edge of each kidney, entering the renal sinus.

Structures such as vessels and nerves, and structures that drain the urine from the kidneys, cross the renal sinus through the renal hilum. Posteriorly, the upper portions of the kidneys are located deep with respect to ribs 11 and 123.In the hilum, the renal vein is anterior to the renal artery, which in turn is anterior to the renal pelvis. Within the kidney, the renal sinus is occupied by the pelvis, calyces, vessels, and renal nerves. The renal pelvis is the flattened, funnel-shaped expansion of the upper end of the ureter.

The vertex of the renal pelvis continues with the ureter. The renal pelvis receives two or three major calyces, each of which is divided into two or three minor calyces. Each minor calyx is formed by a renal papilla, the apex of the renal pyramid from which urine is excreted. UretersThey are muscular conduits whose length is 25-30 cm, with a narrow lumen, that transport the urine from the kidneys to the urinary bladder. The ureters run inferiorly from the vertices of the renal pelvis in the hila of the kidneys, and pass over the terminal line at the level of the bifurcation of the common iliac arteries.

Then, they run along the lateral wall of the pelvis and enter the urinary bladder. The abdominal portions of the ureters adhere closely to the parietal peritoneum and are retroperitoneal along their course. Adrenal glandsThey are located between the superomedial side of the kidneys and the diaphragm. They are surrounded by the renal fascia, by which the crura of the diaphragm are connected.

They are separated from the kidneys by a thin partition.The shape and relationships of the adrenal glands differ on both sides. The right gland, pyramidal in shape, is more apical than the left kidney, is located anterolateral to the diaphragm, and is anteromedially in contact with the inferior vena cava and anterolaterally with the liver. The left gland, semilunar in shape, is medial to the upper half of the left kidney and is related to the spleen, stomach, pancreas and left crus of the diaphragm.

Each adrenal gland has a hilum through which the veins and lymphatic vessels leave the gland, while arteries and nerves enter it through various points.The adrenal glands have two parts: the cortex and the medulla. The cortex secretes steroids and androgens. These allow the kidney to retain sodium and water in response to stress, increasing blood volume and pressure. The adrenal medulla is a mass of nervous tissue invaded by capillaries and sinusoids.

It is formed by chromaffin cells that secrete catecholamines, especially adrenaline, into the bloodstream in response to stimuli from presynaptic neurons.The upper (apical) segment is irrigated by the superior (apical) segmental artery; the anterosuperior and anteroinferior segments are irrigated by the anterosuperior and anteroinferior segmental arteries; the lower segment is irrigated by the inferior segmental artery. These arteries originate in the anterior branch of the renal artery.The posterior segmental artery originates in an extension of the posterior branch of the renal artery and supplies the posterior segment of the kidney.The renal veins drain the kidneys and connect variably to form the right and left renal veins. Horseshoe kidneyThe kidney presents different anatomical variations, as described by Watson and Harper, such as pelvic kidney, ectopic crossed kidney, renal agenesis, and horseshoe kidney. It can also have vascular variations such as multiple arteries, overlap of the right renal artery passing over the vena cava, retro-aortic left renal vein, among others.The horseshoe kidney is one of the most common anatomical anomalies and refers to the lateral fusion of the kidneys. It is more common in men, and the isthmus can be formed by a fibrous band or functional parenchyma,.There are several ways to classify the horseshoe kidney: by its macroscopic form and fusion site, its clinical picture, or its vascular distribution.According to the place where the fusion occurs.' U' horseshoe kidney shows medial fusion and is located symmetrically on both sides of the spine.' L' horseshoe kidney results from the lateral fusion between a horizontal and a vertical kidney, and the lateral isthmus is located towards the midline.The horseshoe kidney may be at any height of the normal course expected from the rise of the kidneys, but they are mainly found in the lower portion of the lumbar spine.

This is due to the restricted rise at the level of the origin of the inferior mesenteric artery, approximately between L3 and L5, and anterior to the abdominal aorta and the inferior vena cava. The ureters usually pass through the anterior section of the fused poles and descend medially. They may have arterial supply from the iliac, sacral, mesenteric, or aortic arteries,.Present anomaly, but without pathological changes or symptoms. There is no hydronephrosis or complications since the ureteropyelic junction is wide.Present anomaly without pathological alteration, but the patient complains of symptoms such as abdominal pain, which is caused by compression of the abdominal aorta. There is vascular and nervous compression and multiple urinary disorders such as lithiasis or frequent infections. This anomaly is known as Rovsing syndrome or horseshoe kidney disease.

The pain is exacerbated when the person sits after being in a supine position, or when they go from sitting to standing up.The anomaly occurs with complications. The symptoms are due to pathological conditions. Due to the posterior location of the calyces there is ureteropyelic stricture. There are no individual or group symptoms that indicate specific changes between a horseshoe kidney or a normal one. This anomaly can only be determined by urological diagnostic methods such as excretory urography and retrograde pyelography, CT, sonography, and angiography.For a better organization, six basic patterns have been established that allow to classify the different types of irrigation.

Embriologia Del Sistema Reproductor Pdf

Figure 2 Anatomical detail of the renal hilum and accessory artery in the lower poles of the kidneys.It has been reported that the horseshoe kidney is associated with calyceal, ureteral, and vascular abnormalities. It may have normal irrigation of accessory renal arteries, which originate at different levels and enter through the renal hilum, and also aberrant arteries, which directly enter the poles or the isthmus of the kidney.