A 14 yo was accidentally kicked in the suprapubic area while playing basketball.

The pt presented with hematuria.  What happened to his bladder?

Our patient did not have a bladder injury,  The CT demonstates a pancake kidney which is a developmental anomaly.  He had a contusion of this kidney and hematuria when struck in the abdomen.  The pancake kidney is two kidneys jointed at the medial borderswith the pelvis placed anteriorly.  The halves are drained by their respective collecting systems.

Fusion abnormalities of the kidney were first described in 1938 by Wilmer. The most common type of renal ectopia is the horseshoe kidney with an incidence of 1 in 700 autopsies. The pancake kidney is more rare.

horseshoe kidney

 pancake kidney

pancake kidney

The presence of a pancake kidney may be associated with other developmental anomalies and can be associated with urinary tract infections.  The short ureters are prone to stasis and obstruction. Surgery is not recommended for this problem because of the danger of renal vascular damage and necrosis of the kidney.

The hematuria resolved in our patient and has not recurred.  Case Courtesy of Dr. Noelker.                        

Glenn JF. Fused pelvic kidney. J Urol.  1958:80;7-9.

Eisendrath DN, Phifer FM, Culver HB. Horseshoe kidney. Ann Surg. 1925: 82;735-64.

Looney WW , Dodd DL. An ectopic (pelvic) completely fused kidney associated with various anomalies of the abdominal viscera. Ann Surg.  1926:84;522-4.