Renal Transplantation in a Child with Congenital Renal Agenesis and Abnormal Iliac Vessels: A Surgical Challenge

A 9-year-old male who has been evaluated for recurrent urinary tract infection was found to have right renal agenesis with grade IV Vesicoureteric reflux in the left kidney. He became a case of chronic kidney disease. He underwent Cohen’s left ureteric reimplantation despite the patient’s creatinine level slowly starting to rise, so the patient was put on the transplant list for renal transplantation. His mother came as a voluntary donor. The preoperative assessment was within normal limits; hence, it was planned for right iliac fossa implantation. During the procedure, the patient was found to have a small-sized common iliac artery and an absent internal iliac artery. Hence, anastomosis was done with the renal vessels with the contralateral common iliac vessels, having implanting the kidney in the retroperitoneum through the right iliac fossa incision.