Sagittal Malrotated Kidney with a Large Renal Cyst - a Case Report of a Rare Type of Kidney Malrotation

Sep 29, 2026

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Sagittal malrotated kidney with a large renal cyst is presented as an exceptionally rare anatomical and clinical entity. A 45-year-old man with left loin pain underwent non-contrast CT, showing a large mid-zonal cyst (~8×8×9 cm), small calculi in the lower calyx, and a kidney positioned with a horizontal long axis on the sagittal plane. The orientation suggested an acquired process rather than congenital maldevelopment, emphasizing accidental imaging discovery. The report discusses associated renal anomalies, highlights diagnostic importance, and reviews embryologic mechanisms, referencing the extreme rarity of documented cases.

LanguageEnglish

CategoryHealthcare

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Pages3

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Introduction and importance

Case presentation

Clinical discussion

Conclusion

Keywords

Case Report Sagittal malrotated kidney with a large renal cyst: a case report of a rare type of kidney malrotation Marym Taha Abdelhamid, MDa , Mohamed Saad Sayed, MBBChb , Mira Al Shoufy, MDc , Lava Abdullah, MDd ,* Introduction and importance: Renal malrotation is an uncommon congenital anatomical variation presents with various clinical manifestations; renal malrotations types include: incomplete rotation, reverse rotation, hyperrotation, and nonrotation. Renal malrotation along the sagittal plane, with the kidney’s long axis positioned horizontally, represents an exceptionally rare phenomenon, with only three documented cases worldwide. Case presentation: A 45-year-old man with left-sided loin pain arrived at the urology clinic. Non-contrast computed tomography (CT) findings: few calculi in the lower calyx, a massive mid-zonal renal cyst that measured around 8 × 8 × 9 cm, and a sagittally malrotated kidney along its horizontal axis, which was a sign of an acquired ailment rather than a congenital defect. Clinical Discussion: Most cases of renal malrotation are identified incidentally during imaging studies, such as CT scans, which are often performed for unrelated reasons, including low back pain, urinary tract infections, or hematuria. Malrotation is often associated with other renal abnormalities, such as ectopia, horseshoe kidney, or other renal anomalies. Conclusion: Malrotated kidneys are uncommon and frequently discovered by accident, particularly those with a horizontal axis in the retroperitoneal space. Keywords: congenital kidney malformation, large renal cyst, malrotated kidney, rare case report, sagittally malrotated kidney Introduction Renal malrotation is a rare congenital anomaly that can present with various clinical manifestations[1] . Renal malrotation is an uncommon anatomical variation, found in approximately 1 in 939 autopsies and 1 in 390 hospital admissions. During normal fetal development, the kidneys initially form in the pelvis with their hila directed ventrally. Between 6 and 9 weeks of gestation, they ascend to their final position in the renal fossa while undergoing a 90° ventromedial rotation, which ultimately causes the renal hilum to face medially[2] . Malrotation occurs when this natural rotation process is disrupted, resulting in variations such as nonrotation, incomplete rotation, reverse rotation (where the hilum faces laterally), and hyperrotation (where the hilum faces ventrally, laterally, or dorsally). This disruption leads to a rare yet fascinating anatomical anomaly[3]. Renal malrotation along the sagittal plane, with the aTheodor Bilharz Research Institute, Cairo, Egypt, bFaculty of Medicine, Beni-Suef University, Beni-Suef, Egypt, cLebanese University, Faculty of Medical Sciences, Beirut, Lebanon and dPharmacology and Toxicology Department, Faculty of Pharmacy, IUST, Ghabageb, Syria Sponsorships or competing interests that may be relevant to content are disclosed at the end of this article. *Corresponding author. Address: Pharmacology and Toxicology Department, Faculty of Pharmacy, IUST. Tel.: +963997769874. [E-mail: Lava7abdullah@gmail.com](E-mail: Lava7abdullah@gmail.com) (L. Abdullah). Copyright © 2025 The Author(s). Published by Wolters Kluwer Health, Inc. This isan open access article distributed under the terms of the Creative Commons AttributionNon Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal. Annals of Medicine & Surgery (2026) 88:792–794 Received 17 July 2025; Accepted 31 October 2025 Published online 25 November 2025 [http://dx.doi.org/10.1097/MS9.0000000000004308](http://dx.doi.org/10.1097/MS9.0000000000004308) HIGHLIGHTS ● Renal malrotation is a rare congenital anomaly. ● Sagittally malrotated kidney represents an exceptionally rare phenomenon

FAQs

What is renal malrotation and why is the sagittal type rare?

Renal malrotation is an uncommon congenital anatomical variation that results from disrupted fetal rotation. Sagittal malrotation with the kidney’s long axis positioned horizontally is exceptionally rare, with only a few worldwide reports.

What did the CT scan show in the presented case?

Non-contrast CT showed a massive mid-zonal renal cyst (~8×8×9 cm), a few calculi in the lower calyx, and a kidney sagittally malrotated along a horizontal axis.

How were other conditions and clinical context addressed during evaluation?

The case initially suggested nephrolithiasis or renal colic, but laboratory and clinical findings were unremarkable and imaging redirected the diagnosis. The discussion notes that malrotation is often found incidentally and may coexist with other renal abnormalities.

Sep 29, 2026

Uploaded by awa