FACULTY:  
Dr. Zeeshan Rahman - Consultant Urology

PRESENTING / CHIEF COMPLAINTS:  
The patient presented with pain in the left flank region.  
NCCT KUB showed gross hydronephrosis of the left moiety of a horseshoe kidney. The patient was admitted for further treatment and surgical management.

CLINICAL FINDINGS:  

• Gross hydronephrosis of the left moiety of the horseshoe kidney.  
• A crossing vessel was seen causing the obstruction.

DIAGNOSIS:  
PUJ obstruction of the left moiety of the horseshoe kidney with a crossing vessel.

TREATMENT PERFORMED:  
Left laparoscopic pyeloplasty with DJ stenting under General Anesthesia.

SPECIAL NOTE:  
This case highlights Dr. Zeeshan Rahman’s expertise in successfully completing a laparoscopic pyeloplasty while preserving the crossing vessel causing the obstruction. The surgery involved minimally invasive laparoscopic pyeloplasty, which was made even more challenging due to the presence of crossing vessels. After surgery, the patient recovered well and was discharged on the 3rd postoperative day.

HIGHLIGHTS OF THE CASE:  

• PUJ obstruction in horseshoe kidney – distorted anatomy  
• Severe hydronephrosis.  
• Advanced laparoscopy performed successfully.  
• Successful preservation of the crossing vessels.  
• Stable recovery after treatment.