When anatomy and injury collide: Successful management of high-grade injury to pelvic ectopic kidney with review of literature

Ectopic kidneys are rare congenital anomalies caused by failure of normal renal ascent and are more vulnerable to trauma due to their anatomical variation. High-grade injuries are infrequently reported, and optimal management remains unclear. We report a 23-year-old woman who sustained blunt abdominal trauma with complex pelvic fractures and Class II hemorrhagic shock. Contrast-enhanced computed tomography (CT) revealed a right pelvic ectopic kidney with American Association for Surgery of Trauma (AAST) Grade IV injury, active contrast extravasation, and pelvicalyceal disruption with no arterial bleeding on angiography. She underwent diagnostic laparoscopy for mesenteric repair, retrograde pyelography with double-J stenting, and CT-guided percutaneous drainage for persistent urinoma. Subsequent pyelonephritis was managed with targeted antibiotics. Despite associated injuries and anatomical challenges, renal salvage was achieved without nephrectomy. Literature review demonstrates limited reported cases, with most managed conservatively. This case highlights the feasibility of individualized, multidisciplinary, minimally invasive management in carefully selected stable patients with high-grade ectopic renal injury.