LAUSR

appendix was not positively identified. After discussion with the patient, a CT scan was chosen to visualize the appendix prior to diagnostic laparoscopy, given the surprising finding of an ectopic kidney. The CT demonstrated a right-sided 5-mm calculus at the vesicoureteric junction with associated hydroureteronephrosis and moderate perinephric stranding. The right kidney was malrotated and malpositioned (Figs 1,2). The appendix was visualized and appeared normal. Following the CT scan, the patient underwent stone extraction and ureteric stent insertion. She was subsequently well and discharged home with urology follow-up. Most ectopic kidneys are found incidentally but may present clinically if affected by infection or renal calculi. The abnormal positioning of the kidney may result in a non-classical pattern of pain for renal colic and therefore leads itself to be misdiagnosed as appendicitis. Furthermore, there have been other reports of pathology in an ectopic kidney presenting clinically as acute appendicitis. Multiple papers have described cases of pyelonephritis in a right-sided ectopic kidney that presented clinically as appendicitis. Additionally, in one large study of 100 patients, a right ureteric stone was found to mimic appendicitis for 22 patients. This case of renal colic presenting as right iliac fossa pain and suspected appendicitis highlights the importance of considering abdominal imaging to confirm diagnosis before proceeding to laparoscopic appendicectomy. This patient did not have any other malformations of her urinary tract which is common with the presence of ectopic kidneys. Whilst ectopic kidneys are rare, it is important for surgeons to consider the diagnosis in pelvic pain or in ambiguous abdominal pain presentations. With a right-sided ectopic kidney, it is difficult to diagnose appendicitis without further imaging. By having a high index of suspicion and considering further abdominal imaging, the correct diagnosis can be made and the rate of unnecessary surgery is reduced.