Corona Mortis: A Systematic Review of Literature

Abstract

Our systematic review evaluates surgically relevant information about corona mortis (CM), such as anatomical structure, size, laterality, incidence, and anthropometric correlations. This study aimed to provide data about anastomosis in an attempt to avoid iatrogenic damage during surgery. Articles were searched online using the descriptor “ Corona Mortis ” in PubMed, Biblioteca Virtual em Saúde (BVS) (Literatura Latino-Americana e do Caribe em Saúde [LILACS], MEDLINE, indice bibliografico espaãol en ciencias de la salud [IBECS]), and SciELO database. The time range was set between 1995 and 2020. The articles were selected according to their titles and later the abstracts' relation to our research purpose. All the selected articles were read entirely. A manual search based of the references cited in these articles was also conducted to identify other articles or books of interest. Forty references fulfilled the criteria for this review. The mean incidence of CM was 63% (the majority venous) among 3,107 hemipelvises. The incidence of bilateral CM was lower than that of unilateral variations based on the analysis of 831 pelvises. The mean caliber of the anastomosis was 2.8 mm among 1,608 hemipelvises. There is no consensus concerning the anthropometric influences in CM . Finally, we concluded that CM is not an unusual anatomical variation and that we must not underestimate the risk of encountering the anastomosis during surgery. Anatomical knowledge of CM is, therefore, essential in preventing accidents for surgeons who approach the inguinal and retropubic regions.

Morphologic Study of the Corona Mortis Using the Simlife ® Technology

“…Thanks to the SIMlife ® model, the CMOR caliber was slightly higher than non-perfused vessels with a mean of 3.08 ± 0.40 mm. In Cardoso et al recently study, the mean caliber was about 2.8 mm among 1,608 hemipelvises [32], which is consistent with the 2.75 ± 0.13 mm diameter we reported in Model A. As expected, the CMOR diameter could vary a lot according to the method of exploration, as Berberoğlu et al showed : in their anatomical study, the CMOR diameter was about 3.3.mm (ranging from 2.2 to 4.9 mm), whereas in laparoscopic ndings the diameter was less than 1 mm) [33].…”

“…This data is in line with Cardoso et al's systematic review over 3,107 hemipelvises, which reported a CMOR prevalence of 63% with most veins. The venous pattern seems to be more frequent than the arterious one [25][26] [27]. In the literature, this ratio ranges from 14.3% to 83% [13] [11] varying by the method of exploration (Table 4).…”

Abnormal Obturator Artery with Ipsilateral Inferior Epigastric Artery Passed Behind the Femoral Vein

“…Thus, the vascular variant of abnormal obturator artery encountered, should be held in high regard during pelvic surgery, like hernia repairs or pelvic fractures, especially in obstetric surgery. The abnormal obturator artery can easily cause massive hemorrhage during obstetric surgery, which has been the leading cause of obstetrical mortality in the developing world (Cardoso et al, 2021). Therefore, obstetric surgeons must have a full awareness of the internal iliac artery branching patterns and any potential vascular abnormalities.…”

“…Although the two arteries were very close to each other, there was no anastomotic branch between them. Although these variations aren't as tricky as Corona Mortis (Darmanis et al, 2007;Cardoso et al, 2021), it is still important for surgeons to plan an anterior approach to the acetabulum before the actual surgery, such as the ilioinguinal or intrapelvic approaches (modified Stoppa), to avoid injuring these abnormal arteries near the superior pubic ramus (Darmanis et al, 2007). Meanwhile, if a patient develops a fracture of the superior ramus of the pubis, there is also the possibility of injuring these abnormal arteries and causing massive bleeding.…”

Hematoma retropúbico masivo posterior a TVT. Enfrentamientos diferentes para una complicación infrecuente

“…Corona mortis significa «corona de la muerte» en latín, porque una lesión en esta estructura puede resultar en una hemorragia significativa. El daño iatrogénico más común ocurre en intervenciones quirúrgicas de hernias inguinales, incontinencia y ortopédicas 6 . La incidencia estimada de CM arterial varía en los estudios más grandes entre el 14% y el 33%; sin embargo, la incidencia de complicaciones quirúrgicas atribuidas a esta lesión vascular es baja 7 .…”