Case of the Month: February 2013 Page 6

Discussion: 
 

  • Solid organ injury due to blunt trauma occurs most frequently to the spleen followed by the liver due to compression by the ribs. The pancreas is relatively vulnerable because it crosses midline over the vertebrae. Thus a strong enough force can either contuse or lacerate the neck of the pancreas by compressing it against the spine. Normal kidneys are positioned on either side of the spine in the retroperitoneum. Injury due to compression against the spine and the ribs are less frequent. In horseshoe kidney, the kidneys are fused at the midline and remain low in the abdomen because their superior migration during development is halted by the inferior mesenteric artery. Thus, this configuration of the kidneys makes them more vulnerable because they cross over the spine at midline like the pancreas does.
  • Horseshoe kidney is the most common renal anomaly and is found in 1 out of 400 people in the population. It is not uncommon for patient’s to be asymptomatic and unaware of this condition. However, it is not to say that there are no other potential complications besides from vulnerability to trauma. There is an increased incidence of renal stones, hydronephrosis and infection because of the abnormal position of the ureteropelvic junction. There is also a 2-8x increased risk for Wilm’s tumor in children and transitional cell carcinoma in adults.

 

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