Abstract: FR-PO0998
Anomalous Gonadal Artery Ligation Leading to Uterine Necrosis in a Living Kidney Donor
Session Information
- Women's Health and Kidney Diseases
October 23, 2026 | Location: Exhibit Hall A, Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Women's Health and Kidney Diseases
- 2100 Women's Health and Kidney Diseases
Authors
- Khan, Naseer, Medical City Dallas Hospital, Dallas, Texas, United States
- Murad, Haris Farooq, Medical City Dallas Hospital, Dallas, Texas, United States
- Roshan, Sara, Medical City Dallas Hospital, Dallas, Texas, United States
- Ahmad, Hamza, Medical City Dallas Hospital, Dallas, Texas, United States
- Agha, Irfan, Medical City Dallas Hospital, Dallas, Texas, United States
Group or Team Name
- Dallas Renal Group at Medical City Transplant Dallas Texas
Introduction
Living kidney donation is generally safe with low morbidity, but anatomical variations can lead to unexpected complications. While vascular anomalies are common in the renal system, their impact on adjacent organs is rarely documented in donor nephrectomy. This case describes a unique systemic inflammatory response syndrome (SIRS) caused by ischemic uterine necrosis following the ligation of an anomalous gonadal artery.
Case Description
A 44-year-old female with a history of uterine fibroids and stable multiple sclerosis underwent an uneventful left donor nephrectomy. Post-operatively, she developed persistent high-grade fevers (38–39°C), rigors, and severe leukocytosis (WBC >30,000/μL). An exhaustive workup for infection (cultures, TEE), malignancy (PET scan), and hemophagocytic lymphohistiocytosis was negative. Symptoms persisted despite broad-spectrum antibiotics until the development of localized abdominal pain prompted a pelvic MRI, which revealed necrosis within the known uterine fibroids. A retrospective review of pre-operative CT angiography identified an anomalous gonadal artery originating directly from the left renal artery. This vessel served as the primary blood supply to the fibroid uterus and was inadvertently occluded during the renal artery ligation.
Management/Outcome: The patient underwent a total transabdominal hysterectomy. Pathological examination confirmed extensive ischemic necrosis. Following surgery, her fevers and leukocytosis resolved almost immediately, and she remains well with stable renal function.
Discussion
This case highlights a critical "blind spot" in standard pre-donor evaluations. Clinicians must evaluate the entire course of the renal artery for non-renal branches, particularly in donors with known uterine pathology that may increase reliance on anomalous vessels. Ischemic necrosis should be included in the differential diagnosis of post-operative fever of unknown origin and extreme leukocytosis in donors.
Uterine fibroid aberrant vascular supply from gonadal artery (corkscrew). Post–donor nephrectomy ischemic necrosis of Fibroids