Management of hydroureteronephrosis secondary to an aberrant middle rectal artery in a patient with congenital unilateral renal agenesis

Presented here is the case of a 21-year-old man, with a family history of unilateral renal agenesis, who presented with obstruction of his solitary functioning right kidney. Initially thought to be secondary to an obturator fossa hernia on endoscopic and retrograde pyelography assessment, diagnosis of obstruction secondary to an aberrant middle rectal artery was determined at laparotomy and division of this vessel relieved the patient's obstruction without any short-term or long-term complications. To the best of the authors' knowledge, this is the first reported case in the literature of hydroureteronephrosis secondary to an aberrant middle rectal artery.