Trans-peritoneal repair of a juxta-renal abdominal aortic aneurysm with horseshoe kidney complicated by urine leak successfully managed with urinary diversion and selective renal artery embolization

There are a limited number of case reports describing the division of a horseshoe kidney (HSK) during trans- peritoneal repair of an abdominal aortic aneurysm (AAA). We present case of a juxta-renal AAA overlaid by an L shaped HSK, repaired trans- peritoneal with division of the isthmus. This was complicated by post-operative urinoma which was successfully treated interventionally.

This approach was chosen due to the presence of the juxta-renal AAA with the majority of the HSK being perfused by a large left renal artery originating at the neck of the AAA. Temporary bilateral ureteral stents were placed. The isthmus of the HSK was divided followed by open tube graft repair of the AAA. Postoperative workup revealed an abdominal urinoma, which was successfully treated by urinary diversion and selective renal arterial branch embolization. Two years later, patient remains well with no evidence of hydronephrosis or graft infection.