International Journal of Current Research and Review
ISSN: 2231-2196 (Print)ISSN: 0975-5241 (Online)
Bootstrap Slider

Indexed and Abstracted in: SCOPUS, Crossref, CAS Abstracts, Publons, CiteFactor, Open J-Gate, ROAD, Indian Citation Index (ICI), Indian Journals Index (IJINDEX), Internet Archive, IP Indexing, Google Scholar, Scientific Indexing Services, Index Copernicus, Science Central, Revistas Medicas Portuguesas, EBSCO, BOAI, SOROS, NEWJOUR, ResearchGATE, Ulrich's Periodicals Directory, DocStoc, PdfCast, getCITED, SkyDrive, Citebase, e-Print, WorldCat (World's largest network of library content and services), Electronic Journals Library by University Library of Regensburg, SciPeople.

Search Articles

Track manuscript

Readers around the world

Full Html

IJCRR - Vol 09 Issue 02, January, 2017

Pages: 25-28

Date of Publication: 20-Jan-2017

Print Article   Download XML  Download PDF

Bilaterally-Complicated Horseshoe Kidney Associated to Situs Inversus with Levocardia: A Case Report

Author: Rabea Ahmed Gadelkareem

Category: Healthcare

Abstract:Aim: To present a very rare case of bilaterally-complicated horseshoe kidney by nephrolithiasis in a patient with situsinversus
with levocardia and skeletal anomalies.
Case Report: A 41-year-old female presented by right loin pain. Abdominal ultrasound showed bilateral kidney stones with
malrotation, right mild hydronephrosis and transposition of the abdominal organs. Chest X-ray showed the heart normal in the
left side. Also, computed tomography revealed a horseshoe kidney with bilateral stones. After counseling the patient about the
stones treatment options, she preferred extracorporeal shock-wave lithotripsy which was tried on the right side firstly, but it failed.
So, percutaneous nephrolithotripsy was scheduled.
Discussion: Situsinversus is a spectrum of congenital anomalies. Situsinversus totalis is the commonest variety and was reported
with renal congenital anomalies like horseshoe kidney, acquired renal diseases like renal cell carcinoma, and in living kidney
donation. However, situsinversus with levocardia is a rare variety with a known association to the congenital heart defects. Its
association to a complicated horseshoe kidney and scoliosis could not be found in the English literature before the current case.
Moreover, absence of congenital heart defects is extremely rare.
Conclusion: Association of situsinversus with levocardia to skeletal anomalies and complicated horseshoe kidney is a unique
situation. It indicates meticulous evaluation and management.

Keywords: Horseshoe kidney, Levocardia, Nephrolithiasis, Situsinversus

Full Text:


Situsinversus anomaly is the mirror image transposition of the thoracic and abdominal organs around the midline with multiple variants[1]. Situsinversus totalis includes dextrocardia representing the complete extreme variant of the spectrum[1, 2].This spectrum could be associated to renal anomalies like horseshoe kidney which is the commonest renal fusion anomaly with an isthmus connecting the lower poles. However, situsinversus with levocardia or isolated levocardia is an extremely rare variant [1, 3]. The heart is seen in its normal levo position in the chest, while the abdominal viscera are in the dextro position [1, 4, 5]. It is mostly associated to congenital heart defects [1]. Few cases without major heart anomalies lived long [6, 7]. So, the diagnosis of the combination of situsinversus anomalies to horseshoe kidney and management of its overt cases are challenging[8]. This article describes a rare case of horseshoe kidney complicated by bilateral stones in a patient with situsinversus with levocardia and skeletal anomalies.

Case report

A 41-year-old female patient presented by right loin pain of many months duration. She was single with no previous significant medical or urological history. On examination, she was tall, and generally looked healthy. Abdominal ultrasound revealed liver and spleen transposition, bilateral kidney stones, mildly dilated right kidney pelvicalyceal system and malrotation. Also, Kidney-Ureter-Bladder imaging films showed bilateral dense kidney stones with right lumbar scoliosis and right-sided small sacral bone defect (Figs. 1 and 3). Chest X-ray showed the heart in the normal left-sided position and so its apex direction (Fig. 2). Transverse cuts of the non-contrast computed tomography of the abdomen confirmed the diagnosis of situsinversus of the abdominal organs, horseshoe kidney with its isthmus and mildly dilated right pelvicalyceal system, tilted vertebrae of scoliosis, and nephrolithiasis (Fig. 4). Both kidney moieties were low in position and the right one was relatively higher and larger than the left (Figs. 3 and 4). In the right moiety, computed tomography described two stones; pelvic (16 mm x 14.6 mm) and upper calyx (3 mm x 2 mm). Also, there were two left stones; pelvic (11.4 mm x 9.7 mm)and lower calyceal (3 mm x 3 mm) stones (Fig. 3 and4). The average Hounsfield Unit values of the right and left kidney stones were 604 and 610, respectively. Examination revealed no upper respiratory tract disorders. Also, she was virgin and the gynecological evaluation was irrelevant. Cardiac evaluation by electrocardiogram and echocardiography revealed normal findings.

The patient was counseled for the anomalies and the possible lines for stones treatment which were extracorporeal shock wave lithotripsy and percutaneous nephrolithotripsy. She preferred shock wave lithotripsy to percutaneous nephrolithotripsy. Considering the anatomical challenges of situsinversus, scoliosis and the mild degree of hydronephrosis, I agreed to this preference as an initial option. Unfortunately, two sessions of shock wave lithotripsy failed to affect right side stone topography. So, percutaneous nephrolithotripsy was scheduled. However, the patient seemed to be unconvinced with this decision and she did not fit for the date of operation.


Etiology of situsinversus anomalies was attributed to the biological expression of a certain protein that affects the heart looping during embryogenesis. Mostly, it has an autosomal recessive inheritance pattern [2]. Organ situsanomalies represent a spectrum and classified into situssolitus (the normal variant), situsinversus totalis (the commonest), situsinversus with levocardia, isolated dextrocardia and situs ambiguous [1].

Horseshoe kidney is a fusion anomaly with a reported incidence of 0.25% [9]. It is attributed to the abnormal migration of the posterior nephrogenic cells. However, mechanical forces may have a role in the anatomical orientations of the horseshoe kidney including the relatively low position and malrotation[10]. The typical anatomical findings were described and illustrated in the present case.

The urologist may meet situsinversus anomalies as an association to one of the following genitourinary disorder categories; congenital disorders only[10, 11], acquired disorders only [8], combination of congenital and acquired disorders[12] or without any disorders like in living kidney donation[13].

The present case belonged to the combined disorders category. Coincident combination of the multiple unrelated rare anomalies is very rare medical situation [10]. Therefore, further congenital or acquired disease combinations usually attribute to extremely rare situations. This could be applied to the current combination of situsinversus with levocardia, skeletal anomalies, and horseshoe kidney which was complicated by nephrolithiasis and hydronephrosis. Moreover, an extremely rare feature in this case of situsinversus with levocardia is the absence of the congenital heart defects which were reported up to 100% ofcases [1]. Similarly, Imamura et al. [3] and Jo et al. [5]reported single cases of this variant without congenital heart defects in adults. Only, few cases of situsinversus with levocardia were reported with urological disorders including adrenal adenoma [7] and micropenis[3]. However, similar presentations to the current case included cases of horseshoe kidney and the common variant situsinversus totalis combined to cilia defects syndromes like Kartagener syndrome [12], or combined to Klippel-Feil syndrome. These syndromes consist of the heart anomalies, skeletal anomalies including scoliosis and renal anomalies including the horseshoe kidneys[14].

Association of situsinversus to nephrolithiasis is a rare finding[15]. Moreover, association of horseshoe kidney/situsinversus combination to nephrolithiasis could be detected very rarely in publications [2]. Accordingly and again, addition of a common congenital or acquired disorder to a rare anomaly, solely or in combinations, will create a rare situation too. The evidence evolves from the literature, where nephrolithiasis is common with horseshoe kidney reaching up to 60% [9], but it is rarely reported in combinations of situsinversus and horseshoe kidney[2].

Anatomical and metabolic abnormalities of horseshoe kidney predispose to nephrolithiasis[9]. In such cases, shock wave lithotripsy is the preferred treatment method for small stones (≤15 mm), while percutaneous nephrolithotripsy is the standard line of treatment for larger stones or after failed shock wave lithotripsy. However, anatomical challenges are considered in decision-making[9, 11]. Accordingly, relatively hard stones with multiple rare anatomical anomalies may indicate the non-invasive lines of treatment. So, in the current case, shock wave lithotripsy was tried firstly, although it failed, mostly, due to stone impaction or localization issues. Then, shift to percutaneous lithotripsy was the logic following step. However, missing of the patient at the scheduled dates might make the situation incomplete.

To the best of my knowledge, the current case is the first one to be reported with this constellation of congenital anomalies and presented by urological symptoms; situsinversus with levocardia(without congenital heart defects), skeletal deformities and horseshoe kidney complicatedby nephrolithiasis and hydronephrosis.


Association of situsinversus with levocardia(without congenital heart defects) and skeletal anomalies to a bilaterally nephrolithiasis-complicated horseshoe kidney is very rare entity and novel urological situation. Meticulous evaluation is indicated to exclude the high possibilities of congenital heart defects co-existence and choose the best line for treatment of complications.


I acknowledge the immense help received from the scholars whose articles are cited and included in reference of this article. I’m grateful to authors / edi­tors / publishers of all those articles and journals from where the literature for this article has been reviewed and discussed.

Ethical approval

Ethical committee of the Faculty of Medicine in Assiut University approved this case study. Informed consent was taken from the patient.

Funding: None

Conflict of interest: None


  1. Fulcher, A.S., Turner, M.A., Abdominal manifestations of situs anomalies in adults. Radiographics, 2002 Nov-Dec. 22(6): p. 1439-1456.
  2. Kaushik, R., Chandrakar, K., Ksheersagar, D., et al., Situs inversus totalis- A case report. J Cont Med A Dent 2015 Jan-Apr. 3(1): p. 97-99.
  3. Imamura, T., Momoi, N., Go, H., et al., Rare case of isolated levocardia with polysplenia including normally structured lung without cardiac anomaly. Congenit Anom (Kyoto), 2011 Dec. 51(4): p. 187-190.
  4. Abdullah, N.L., Quek, S.C., Seto, K.Y., Teo, L.L., Clinics in diagnostic imaging (160). Levocardia with abdominal situs inversus. Singapore Med J, 2015 Apr. 56(4): p. 198-201; quiz 202.
  5. Jo, D.S., Jung, S.S., Joo, C.U., A case of unusual visceral heterotaxy syndrome with isolated levocardia. Korean Circ J, 2013 Oct. 43(10): p. 705-709.
  6. Sugiura, M., Okada, R., Hiraoka, K., Isolated levocardia with polysplenia in an aged with special reference to minor cardiac abnormalities. Jap Heart J, 1968 Nov. 9(6): p. 603-608.
  7. Toutounchi, S., Krajewska, E., Fiszer, P., et al., Laparoscopic adrenalectomy in a patient with situs inversus levocardia. Wideochir Inne Tech Maloinwazyjne, 2012 Aug. 7(3): p. 213-215.
  8. Treiger, B.F., Khazan, R., Goldman, S.M., Marshall, F.F., Renal cell carcinoma with situs inversus totalis. Urology, 1993 May. 41(5): p. 455-457.
  9. Ding, J., Huang, Y., Gu, S., et al., Flexible ureteroscopic management of horseshoe kidney renal calculi. Int Braz J Urol, 2015 Jul-Aug. 41(4): p. 683-9.
  10. Chaturvedi, P., Thomas, K., Congenital renal anomaly in a patient with situs inversus. Postgrad Med J, 2003 Jun. 79(932): p. 355-359.
  11. Cimen, H.I., Atik, Y.T., Adsan, O., Laparoscopic simple nephrectomy patient with situs inversus totalis and left renal hypoplasia: A case report. Can Urol Assoc J, 2015 Jul-Aug. 9(7-8): p. E521-523.
  12. Sa?lam, E., Türk, A., Selimo?lu, A., et al., Renal cell carcinoma in a patient with Kartagener syndrome: First case report in English language. J Urol Surg, 2015. 1: p. 33-35.
  13. Gonzalez-Heredia, R., Garcia-Roca, R., Benedetti, E., Hand-assisted robotic right donor nephrectomy in patient with total situs inversus: A case report. Int J Surg Case Rep, 2016. 23: p. 44-46.
  14. Bejiqi, R., Retkoceri, R., Bejiqi, H., Zeka, N., Klippel - Feil Syndrome associated with congential heart disease presentaion of cases and a review of the curent literature. Open Access Maced J Med Sci, 2015 Mar. 3(1): p. 129-134.
  15.  Senayli, Y., , Kaya, Z., Senayli, A., Xzkan, F., Pyelolithiasis based on ureteropelvic junction obstruction with situs inversus totalis: Handling of a child. Intern J Urol, 2009 Jul. 6(1): p. 8.

Research Incentive Schemes

Awards, Research and Publication incentive Schemes by IJCRR

Best Article Award: 

One article from every issue is selected for the ‘Best Article Award’. Authors of selected ‘Best Article’ are rewarded with a certificate. IJCRR Editorial Board members select one ‘Best Article’ from the published issue based on originality, novelty, social usefulness of the work. The corresponding author of selected ‘Best Article Award’ is communicated and information of award is displayed on IJCRR’s website. Drop a mail to for more details.

Women Researcher Award:

This award is instituted to encourage women researchers to publish her work in IJCRR. Women researcher, who intends to publish her research work in IJCRR as the first author is eligible to apply for this award. Editorial Board members decide on the selection of women researchers based on the originality, novelty, and social contribution of the research work. The corresponding author of the selected manuscript is communicated and information is displayed on IJCRR’s website. Under this award selected women, the author is eligible for publication incentives. Drop a mail to for more details.

Emerging Researcher Award:

‘Emerging Researcher Award’ is instituted to encourage student researchers to publish their work in IJCRR. Student researchers, who intend to publish their research or review work in IJCRR as the first author are eligible to apply for this award. Editorial Board members decide on the selection of student researchers for the said award based on originality, novelty, and social applicability of the research work. Under this award selected student researcher is eligible for publication incentives. Drop a mail to for more details.

Best Article Award

A Study by Juna Byun et al. entitled "Study on Difference in Coronavirus-19 Related Anxiety between Face-to-face and Non-face-to-face Classes among University Students in South Korea" is awarded Best Article for Vol 12 issue 16
A Study by Sudha Ramachandra & Vinay Chavan entitled "Enhanced-Hybrid-Age Layered Population Structure (E-Hybrid-ALPS): A Genetic Algorithm with Adaptive Crossover for Molecular Docking Studies of Drug Discovery Process" is awarded Best article for Vol 12 issue 15
A Study by Varsha M. Shindhe et al. entitled "A Study on Effect of Smokeless Tobacco on Pulmonary Function Tests in Class IV Workers of USM-KLE (Universiti Sains Malaysia-Karnataka Lingayat Education Society) International Medical Programme, Belagavi" is awarded Best article of Vol 12 issue 14, July 2020
A study by Amruta Choudhary et al. entitled "Family Planning Knowledge, Attitude and Practice Among Women of Reproductive Age from Rural Area of Central India" is awarded Best Article for special issue "Modern Therapeutics Applications"
A study by Raunak Das entitled "Study of Cardiovascular Dysfunctions in Interstitial Lung Diseas epatients by Correlating the Levels of Serum NT PRO BNP and Microalbuminuria (Biomarkers of Cardiovascular Dysfunction) with Echocardiographic, Bronchoscopic and HighResolution Computed Tomography Findings of These ILD Patients" is awarded Best Article of Vol 12 issue 13 
A Study by Kannamani Ramasamy et al. entitled "COVID-19 Situation at Chennai City – Forecasting for the Better Pandemic Management" is awarded best article for  Vol 12 issue 12
A Study by Muhammet Lutfi SELCUK and Fatma COLAKOGLU entitled "Distinction of Gray and White Matter for Some Histological Staining Methods in New Zealand Rabbit's Brain" is awarded best article for  Vol 12 issue 11
A Study by Anamul Haq et al. entitled "Etiology of Abnormal Uterine Bleeding in Adolescents – Emphasis Upon Polycystic Ovarian Syndrome" is awarded best article for  Vol 12 issue 10
A Study by Arpita M. et al entitled "Estimation of Reference Interval of Serum Progesterone During Three Trimesters of Normal Pregnancy in a Tertiary Care Hospital of Kolkata" is awarded best article for  Vol 12 issue 09
A Study by Ilona Gracie De Souza & Pavan Kumar G. entitled "Effect of Releasing Myofascial Chain in Patients with Patellofemoral Pain Syndrome - A Randomized Clinical Trial" is awarded best article for  Vol 12 issue 08
A Study by Virendra Atam et. al. entitled "Clinical Profile and Short - Term Mortality Predictors in Acute Stroke with Emphasis on Stress Hyperglycemia and THRIVE Score : An Observational Study" is awarded best article for  Vol 12 issue 07
A Study by K. Krupashree et. al. entitled "Protective Effects of Picrorhizakurroa Against Fumonisin B1 Induced Hepatotoxicity in Mice" is awarded best article for issue Vol 10 issue 20
A study by Mithun K.P. et al "Larvicidal Activity of Crude Solanum Nigrum Leaf and Berries Extract Against Dengue Vector-Aedesaegypti" is awarded Best Article for Vol 10 issue 14 of IJCRR
A study by Asha Menon "Women in Child Care and Early Education: Truly Nontraditional Work" is awarded Best Article for Vol 10 issue 13
A study by Deep J. M. "Prevalence of Molar-Incisor Hypomineralization in 7-13 Years Old Children of Biratnagar, Nepal: A Cross Sectional Study" is awarded Best Article for Vol 10 issue 11 of IJCRR
A review by Chitra et al to analyse relation between Obesity and Type 2 diabetes is awarded 'Best Article' for Vol 10 issue 10 by IJCRR. 
A study by Karanpreet et al "Pregnancy Induced Hypertension: A Study on Its Multisystem Involvement" is given Best Paper Award for Vol 10 issue 09
Late to bed everyday? You may die early, get depression
Egg a day tied to lower risk of heart disease
88 Percent Of Delhi Population Has Vitamin D Deficiency: ASSOCHAM Report

List of Awardees

Awardees of COVID-19 Research

Woman Researcher Award

A Study by Neha Garg et al. entitled "Optimization of the Response to nCOVID-19 Pandemic in Pregnant Women – An Urgent Appeal in Indian Scenario" published in Vol 12 issue 09

A Study by Sana Parveen and Shraddha Jain entitled "Pathophysiologic Enigma of COVID-19 Pandemic with Clinical Correlates" published in Vol 12 issue 13

A Study by Rashmi Jain et al. entitled "Current Consensus Review Article on Drugs and Biologics against nCOVID-19 – A Systematic Review" published in Vol 12 issue 09

Emerging Researcher Award

A Study by Madhan Jeyaraman et al. entitled "Vitamin-D: An Immune Shield Against nCOVID-19" published in Vol 12 issue 09

RSS feed

Indexed and Abstracted in

Antiplagiarism Policy: IJCRR strongly condemn and discourage practice of plagiarism. All received manuscripts have to pass through "Plagiarism Detection Software" test before forwarding for peer review. We consider "Plagiarism is a crime"

IJCRR Code of Conduct: We at IJCRR voluntarily adopt policies on Code of Conduct, and Code of Ethics given by OASPA and COPE. To know about IJCRRs Code of Conduct, Code of Ethics, Artical Retraction policy, Digital Preservation Policy, and Journals Licence policy click here

Disclaimer: International Journal of Current Research and Review (JICRR) provides platform for researchers to publish and discuss their original research and review work. IJCRR can not be held responsible for views, opinions and written statements of researchers published in this journal.

Company name

International Journal of Current Research and Review (JICRR) provides platform for researchers to publish and discuss their original research and review work. IJCRR can not be held responsible for views, opinions and written statements of researchers published in this journal


148, IMSR Building, Ayurvedic Layout,
        Near NIT Complex, Sakkardara,
        Nagpur-24, Maharashtra State, India

Copyright © 2020 IJCRR. Specialized online journals by ubijournal .Website by Ubitech solutions