# Importance of Considering the Duplex Collecting System During Routine Endourological Procedures: A Case Report

## TL;DR

A case report highlights the importance of recognizing a duplicated kidney system during medical procedures, even when imaging fails to detect it.

## Contribution

This case emphasizes the clinical significance of anatomic variants during endourological procedures.

## Key findings

- A duplicated collecting system was identified during stent placement despite normal imaging results.
- Anatomic variants may not be reliably detected by diagnostic imaging.
- Recognition of such anomalies is crucial for effective patient management.

## Abstract

We report the case of a 58-year-old woman who initially presented to the emergency department with intermittent nausea, vomiting, and left upper quadrant abdominal pain for six days. As part of the abdominal pain workup in the emergency department, contrast-enhanced abdominopelvic CT and laboratory assessment were performed, which were consistent with pyelonephritis secondary to a distal ureteral stone. Interestingly, while the imaging failed to detect any significant anatomic variation, a duplicated collecting system was diagnosed during ureteral stent placement. Recognition of this anomaly was crucial for successful patient management. Awareness of anatomic variants is essential during endourological procedures, as diagnostic imaging may not reliably detect them.