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Schaible SF, Hanke MS, Tinner C, Bastian JD, Albers CE, Keel MJB. Corona mortis: clinical evaluation of prevalence, anatomy, and relevance in anterior approaches to the pelvis and acetabulum. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY & TRAUMATOLOGY : ORTHOPEDIE TRAUMATOLOGIE 2024; 34:1397-1404. [PMID: 38197970 PMCID: PMC10980617 DOI: 10.1007/s00590-023-03808-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/27/2023] [Accepted: 12/03/2023] [Indexed: 01/11/2024]
Abstract
PURPOSE To evaluate the clinical prevalence, characteristics, and relevance of the corona mortis (CM) in anterior approaches to the pelvis and acetabulum. METHODS Retrospective analysis of 185 theater reports from patients (73 females; mean age 62.8 ± 17.2 years) who underwent surgeries for pelvic ring injuries, acetabular fractures, or combined injuries using anterior approaches (Modified Stoppa or Pararectus) at our institution between 01/2008 to 12/2022. During procedures, the CM was routinely identified, evaluated, and occluded. Bilateral exposure of the superior pubic branch in 25 cases led to 210 hemipelvises analyzed. EXCLUSIONS CM not mentioned in report and revisions via the initial approach. RESULTS In the 210 hemipelvises examined, the prevalence of any CM vessel was 81% (170/210). Venous anastomoses were found in 76% of hemipelvises (159/210), arterial in 22% (47/210). Sole venous anastomoses appeared in 59% (123/210), sole arterial in 5% (11/210). Both types coexisted in 17% (36/210), while 19% (40/210) had none. A single incidental CM injury occurred without significant bleeding. In ten cases, trauma had preoperatively ruptured the CM, but bleeding was readily managed. Females had a significantly higher CM prevalence than males (p = 0.001). CONCLUSION Our findings show a CM prevalence aligning more with anatomical studies than prior intraoperative series. Although we observed one incidental and ten trauma-related CM injuries, we did not encounter uncontrollable bleeding. Our data suggest that in anterior pelvic approaches, when the CM is actively identified and occluded, it is not associated with bleeding events, despite its high prevalence.
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Affiliation(s)
- Samuel Friedrich Schaible
- Department of Orthopaedic Surgery and Traumatology, University Hospital Bern, Inselspital, University of Bern, CH-3010, Bern, Switzerland.
| | - Markus Simon Hanke
- Department of Orthopaedic Surgery and Traumatology, University Hospital Bern, Inselspital, University of Bern, CH-3010, Bern, Switzerland
| | - Christian Tinner
- Department of Orthopaedic Surgery and Traumatology, University Hospital Bern, Inselspital, University of Bern, CH-3010, Bern, Switzerland
| | - Johannes Dominik Bastian
- Department of Orthopaedic Surgery and Traumatology, University Hospital Bern, Inselspital, University of Bern, CH-3010, Bern, Switzerland
| | - Christoph Emanuel Albers
- Department of Orthopaedic Surgery and Traumatology, University Hospital Bern, Inselspital, University of Bern, CH-3010, Bern, Switzerland
| | - Marius Johann Baptist Keel
- Department of Orthopaedic Surgery and Traumatology, University Hospital Bern, Inselspital, University of Bern, CH-3010, Bern, Switzerland
- Trauma Center Hirslanden, Clinic Hirslanden Zurich, Medical School University of Zurich, Witellikerstrasse 40, CH-8032, Zurich, Switzerland
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David G, Milliot N, Rony L, Fournier HD, Demondion X, Bernard F. Corona mortis and pelvic dissection: Understanding the relationship between anatomical structures and bone areas. J Anat 2024; 244:458-467. [PMID: 37990973 PMCID: PMC10862173 DOI: 10.1111/joa.13978] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Revised: 10/26/2023] [Accepted: 11/02/2023] [Indexed: 11/23/2023] Open
Abstract
Pelvic fractures are becoming increasingly frequent. The gold standard for surgical managements remains open procedures. Despite its excellent biomechanically results, it can lead to many complications. Minimally invasive surgery could reduce these complications. For complex pelvic trauma, extraperitoneal endoscopic technique has never been described. The aim of this study is to determine anatomical landmarks which are useful for endoscopic pelvic ring surgery using an extraperitoneal approach. The second objective is to compare this minimally invasive procedure to expose the bone versus a traditional open approach. After preparing the vessels with latex injections, 10 specimens are dissected alternately, using an endoscopic method (MIS) on one side and an open method on the other side. Both procedures are performed on the same subject. The visualized bone areas are drilled with burr holes. The marked surfaces are measured with photogrammetry. Finally, the data are processed (surface analysis). An extraperitoneal endoscopic dissection that follows anatomical landmarks can be performed. Bone area (mm2 ) visualized by endoscopy was 74 ± 14 (59-94) compared to 71 ± 16 (48-94) by open method. Paired t-test was performed with no significant difference between the two methods. Skin and muscular incisions were significantly lower in the MIS group (5.1, IC95% [4.1; 6.1], p < 0.001). An extraperitoneal endoscopic dissection of the pelvis can be performed. We also find no significant difference between our method and an open traditional approach concerning bone exposure. We offer a holistic approach to treat pelvic fractures by identifying key anatomical structures.
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Affiliation(s)
- Guillaume David
- Laboratoire d'Anatomie, Faculté de Médecine, Angers, France
- Département de Chirurgie Osseuse, Centre Hospitalo-Universitaire, Angers, France
| | - Nathan Milliot
- Laboratoire d'Anatomie, Faculté de Médecine, Angers, France
- Département de Chirurgie Osseuse, Centre Hospitalo-Universitaire, Angers, France
| | - Louis Rony
- Département de Chirurgie Osseuse, Centre Hospitalo-Universitaire, Angers, France
| | - Henri-Dominique Fournier
- Laboratoire d'Anatomie, Faculté de Médecine, Angers, France
- Service de Neurochirurgie, Centre Hospitalo-Universitaire, Angers, France
| | - Xavier Demondion
- Laboratoire d'Anatomie, Faculté de Médecine, Lille, France
- Service de Radiologie ostéoarticulaire, Hôpital Roger Salengro, CHRU de Lille, Lille, France
| | - Florian Bernard
- Laboratoire d'Anatomie, Faculté de Médecine, Angers, France
- Service de Neurochirurgie, Centre Hospitalo-Universitaire, Angers, France
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Khirul-Ashar NA, Ismail II, Hussin P, Nizlan NM, Harun MH, Mawardi M, Lingam R. The Incidence and Variation of Corona Mortis in Multiracial Asian: An Insight from 82 Cadavers. Malays Orthop J 2024; 18:26-32. [PMID: 38638662 PMCID: PMC11023341 DOI: 10.5704/moj.2403.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Accepted: 08/14/2023] [Indexed: 04/20/2024] Open
Abstract
Introduction Corona Mortis (CMOR) is a term used to describe an anatomical vascular variant of retropubic anastomosis located posterior to superior pubic ramus. We aim to provide sufficient data on the incidence, morphology and mean location of 'crown of death' in Asian population. Other objectives include to assess the relationship between CMOR incidence with gender, race and age. Materials and methods This is a cross-sectional cadaveric study involving 164 randomly selected fresh multiracial Asian hemipelves (82 cadavers). Hemipelves were dissected to expose and evaluate the vascular elements posterior to superior pubic rami. Data were analysed using Chi-Square, t-test and with the help of IBM SPSS Statistics v26 software. Results CMOR was found in 117 hemipelves (71.3%). No new morphological subtype was found. The mean distance of CMOR to symphysis pubis was 54.72mm (SD 9.35). Based on the results, it is evident that precaution needed to be taken at least within 55mm from symphysis pubis during any surgical intervention. The lack of statistically significant correlation between CMOR occurrence and gender, race and age suggest that the incidence of CMOR could be sporadic in manner. Conclusion We conclude that CMOR is not just aberrant vessel as the incidence is high and this finding is comparable to other studies. The mean location of CMOR obtained in this study will guide surgeons from various disciplines in Asia to manage traumatic vascular injury and to perform a safe surgical procedure involving the pelvis area.
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Affiliation(s)
- N A Khirul-Ashar
- Department of Orthopaedic and Traumatology, Universiti Teknologi MARA, Sungai Buloh, Malaysia
| | - I I Ismail
- Department of Orthopaedics, Universiti Putra Malaysia, Serdang, Malaysia
| | - P Hussin
- Department of Orthopaedics, Universiti Putra Malaysia, Serdang, Malaysia
| | - N M Nizlan
- Department of Orthopaedics, Universiti Putra Malaysia, Serdang, Malaysia
| | - M H Harun
- Department of Orthopaedics, Universiti Putra Malaysia, Serdang, Malaysia
| | - M Mawardi
- Department of Family Medicine, Universiti Putra Malaysia, Serdang, Malaysia
| | - R Lingam
- Department of Orthopaedics, Hospital Serdang, Serdang, Malaysia
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Marvanova Z, Kachlik D. The anatomical variability of obturator vessels: Systematic review of literature. Ann Anat 2024; 251:152167. [PMID: 37865385 DOI: 10.1016/j.aanat.2023.152167] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Revised: 10/01/2023] [Accepted: 10/10/2023] [Indexed: 10/23/2023]
Abstract
OBJECTIVE To systematically assess available information about all variations of obturator vessels and to present the most surgically relevant types, their prevalence and calibre in order to provide a comprehensive overview for both anatomists and clinicians. MATERIALS AND METHODS A total of 2689 studies were found via searching the online databases. After applying exclusion criteria 44 studies were assessed. The cadaveric studies, CT angiographies, and clinical studies were included. Number of hemipelves, prevalence of each variation and calibre of identified vessels were studied. Each variation was classified as aberrant obturator artery/vein, aberrant accessory obturator artery/vein or anastomosis. RESULTS In included studies the average incidence of the variant obturator artery was 26% with the aberrant obturator artery being the most frequent type (with the mean calibre 2.10 mm, SD = 0.35 mm), while the overall incidence of the variant obturator vein was 55%. Presented venous structures had the mean calibre of 2.98 mm (SD = 0.56 mm). CONCLUSIONS According to reviewed studies, variant obturator vessels are present in a great number of patients. Due to their possible calibre larger than 3 mm they represent a structure of high clinical importance. It is important to unify the terminology and to stress out the significance to all clinicians.
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Affiliation(s)
- Zuzana Marvanova
- Department of Anatomy, Second Faculty of Medicine, Charles University, Prague, Czech Republic; Centre for Endoscopic, Surgical and Clinical Anatomy (CESKA), Second Faculty of Medicine, Charles University, Prague, Czech Republic
| | - David Kachlik
- Department of Anatomy, Second Faculty of Medicine, Charles University, Prague, Czech Republic; Centre for Endoscopic, Surgical and Clinical Anatomy (CESKA), Second Faculty of Medicine, Charles University, Prague, Czech Republic.
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Moramarco L, Grande AM, Vertemati M, Aseni P. Prostate Artery Embolization in the Treatment of Massive Intractable Bleeding from Prostatic Neoplasms: A Case Report and Systematic Review. J Clin Med 2023; 13:65. [PMID: 38202072 PMCID: PMC10780233 DOI: 10.3390/jcm13010065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Revised: 12/12/2023] [Accepted: 12/19/2023] [Indexed: 01/12/2024] Open
Abstract
Lower urinary tract symptoms (LUTS) and hematuria are common symptoms in men with neoplasms, mainly affecting the elderly population. Prostatic arterial embolization (PAE) is a minimally invasive procedure that has shown promising results in managing LUTS and massive intractable prostatic hematuria in patients with benign prostatic hyperplasia (BPH) and prostate cancer (PCa). A few studies, however, have provided valuable insights into the durability and efficacy of PAE focusing on the long-term effectiveness, quality of life, and cancer-specific control of hemostasis and urinary symptoms. As a result of concomitant cardiovascular conditions, these patients often take anticoagulants or antithrombotics, which can worsen their hematuria and clinical status. Transurethral resection of the prostate (TURP) is considered a very high-risk procedure, even without massive bleeding, and requires discontinuation of vitamin K antagonists and antiplatelet therapies. Such patients usually have their surgery postponed, and PAE should be considered a safe alternative treatment. We aimed to report a narrative review from 1976 to June 2023 of the current state of PAE for massive and intractable hematuria, highlighting recent developments in this technique, including prospective cohort studies, and focusing on long-term outcome, safety, and complication management of patients with prostatic neoplasms who develop significant hemorrhagic symptoms. Additionally, we present a case report and a simple algorithm for treating intractable bleeding in a 92-year-old man with PCa and massive hematuria.
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Affiliation(s)
- Lorenzo Moramarco
- Radiologia—Neuroradiologia Diagnostica ed Interventistica, Fondazione IRCCS Policlinico San Matteo, 27100 Pavia, Italy;
| | - Antonino M. Grande
- Divisione Cardiochirurgia, Fondazione IRCCS Policlinico San Matteo, 27100 Pavia, Italy;
| | - Maurizio Vertemati
- Department of Biomedical and Clinical Sciences “L. Sacco”, Università degli Studi di Milano, 20157 Milan, Italy;
| | - Paolo Aseni
- Department of Biomedical and Clinical Sciences “L. Sacco”, Università degli Studi di Milano, 20157 Milan, Italy;
- Dipartimento di Emergenza Urgenza, ASST Grande Ospedale Metropolitano Niguarda Hospital, 20162 Milan, Italy
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Almaguer J, Murray D, Murray M, Murray R. Differentiating Between Obturator and Inferior Epigastric Arterial Injury in Traumatic Pelvic Hemorrhage: A Case Report. Cureus 2023; 15:e44593. [PMID: 37667785 PMCID: PMC10475151 DOI: 10.7759/cureus.44593] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/02/2023] [Indexed: 09/06/2023] Open
Abstract
The pubic branches of the inferior epigastric and obturator arteries are subject to injury from pelvic trauma or surgery within the retropubic space. Such injuries can result in severe internal hemorrhage that can lead to hemodynamic instability if not adequately controlled. Due to their anatomical proximity and anastomosis, it is critical to determine which artery is hemorrhaging in order to provide accurate embolization. In the presented case, a geriatric patient suffered a fall from standing height that resulted in bilateral and multiple pelvic fractures. CT angiography of the abdomen demonstrated active left-sided pelvic hemorrhage and a resultant 10 cm anterior extraperitoneal hematoma, likely exacerbated by existing anticoagulant usage. Urgent embolization of the inferior epigastric artery was performed in addition to multiple transfusions. The patient recovered without any procedural complications and was later discharged for rehabilitation.
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Affiliation(s)
- Joey Almaguer
- Department of Radiology, Texas Tech University Health Sciences Center School of Medicine, Amarillo, USA
| | - Dylan Murray
- Department of Surgery, University College Dublin, Dublin, IRL
| | - Matthew Murray
- Department of Surgery, Royal College of Surgeons, Dublin, IRL
| | - Richard Murray
- Department of Diagnostic and Interventional Radiology, Northwest Texas Healthcare System, Amarillo, USA
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Morris CA, Yong TM, Mitchell PM. Non-osseous considerations in diagnostic imaging for pelvic and acetabular trauma. Injury 2023; 54:818-833. [PMID: 36658024 DOI: 10.1016/j.injury.2023.01.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Revised: 12/29/2022] [Accepted: 01/02/2023] [Indexed: 01/09/2023]
Abstract
High-quality imaging is crucial for orthopedic traumatologists in the evaluation and management of pelvic and acetabular fractures. Computed tomography (CT) plays an essential role in the diagnosis and treatment of patients with these complex injuries. A thoughtful evaluation of associated soft tissues can reveal additional details about the patient and their injury that may impact treatment. This review aims to highlight soft tissue findings that should be identified when evaluating the initial diagnostic imaging after pelvic and acetabular trauma.
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Affiliation(s)
- Cade A Morris
- Department of Orthopaedics and Rehabilitation, Vanderbilt University Medical Center, 1215 21st Avenue South, #4200, Nashville, TN 37232, USA
| | - Taylor M Yong
- Department of Orthopaedics and Rehabilitation, Vanderbilt University Medical Center, 1215 21st Avenue South, #4200, Nashville, TN 37232, USA
| | - Phillip M Mitchell
- Department of Orthopaedics and Rehabilitation, Vanderbilt University Medical Center, 1215 21st Avenue South, #4200, Nashville, TN 37232, USA.
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Elhence A, Gupta A. Corona Mortise- anatomical variants and implications in pelvic-acetabular surgery: An evidence based review. J Orthop 2023; 37:9-14. [PMID: 36974088 PMCID: PMC10039118 DOI: 10.1016/j.jor.2023.01.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2022] [Revised: 01/09/2023] [Accepted: 01/26/2023] [Indexed: 01/30/2023] Open
Abstract
Background Corona Mortise is the name given to the anastomotic vessels forming a communication between external and internal iliac vascular systems. These channels have a high tendency to cause uncontrollable bleeding if injured and are particularly at risk during the anterior approach to acetabulum. While previous studies have described them as arterial or venous connections or both, there is still a lack of consensus regarding exact nature and location of these vessels, which make their timely identification all the more challenging. Objective The present review is aimed at performing a comprehensive review of existing literature and discuss the anatomy and implications of correct identification of Corona Mortise in pelvic-acetabular surgery. Conclusion Corona Mortise is more commonly venous than arterial. This not only makes haemorrhage control more challenging but also precludes the use of pre-operative angiography. However, most authors do not recommend a change in surgical approach for fear of damaging these vessels.
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Affiliation(s)
- Abhay Elhence
- Department Of Orthopaedics, All India Institute Of Medical Sciences, Jodhpur, Rajasthan, 342005, India
| | - Akshat Gupta
- Department Of Orthopaedics, All India Institute Of Medical Sciences, Jodhpur, Rajasthan, 342005, India
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Sume BW, Mulu A. Anatomical variations of obturator artery and its clinical significances: A systematic review and meta-analysis. TRANSLATIONAL RESEARCH IN ANATOMY 2023. [DOI: 10.1016/j.tria.2023.100237] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/28/2023] Open
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Beya R, Jérôme D, Tanguy V, My-Van N, Arthur R, Jean-Pierre R, Thierry H, Cyril B, Jean-Pierre F. Morphodynamic study of the corona mortis using the SimLife ® technology. Surg Radiol Anat 2023; 45:89-99. [PMID: 36585462 DOI: 10.1007/s00276-022-03067-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Accepted: 12/20/2022] [Indexed: 01/01/2023]
Abstract
PURPOSE Open book pelvic ring fractures are potentially life-threatening, due to their instability and major hemorrhage risk. During the open reduction and internal fixation, the pelvic approach remains a technical challenge, as the surgeon wants to prevent any iatrogenic damage of the vascular loop located in the retro-pubic area called corona mortis (CMOR). Recently, the cadaver perfused SimLife® technology has been developed to improve the surgeon training, out of the operating room. This study aimed to compare two models of cadaveric dissection, to assess the interest of the perfused SimLife® in providing dynamic aspect of anatomy in the identification of CMOR and its topography. METHODS Twelve human cadaveric pelvises have been dissected, following two protocols. 12 hemi-pelvises of the dissections were performed without perfusion (Model A), whereas the 12 other hemi-pelvises have been prepared with the SimLife® pulsatile perfusion (Model B). The prevalence and morphologic parameters determined: length, diameter and distance between the CMOR and the pubic symphysis. RESULTS The CMOR has been found in 66.67% of the cases. The length, the diameter, and the distance between the CMOR and the pubic symphysis were significantly higher in model B (respectively p = 0.029, p = 0.01, and p = 0.022). CONCLUSION These results suggest that the CMOR is easier to identify and to dissect with the SimLife® perfusion. As part of the surgical training of any trauma surgeon, this model could help him to keep in mind the CMOR topography, to improve the open book lesion management.
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Affiliation(s)
- Robert Beya
- A B S Lab, UFR Medicine and Pharmacy, Bat D1-Porte J 6, Milétrie Street, TSA 51115, 86073, Poitiers Cedex 9, France. .,INSERM U1313-IRMETIST Unity, Research Institute, University, Poitiers, France.
| | - Danion Jérôme
- A B S Lab, UFR Medicine and Pharmacy, Bat D1-Porte J 6, Milétrie Street, TSA 51115, 86073, Poitiers Cedex 9, France.,INSERM U1313-IRMETIST Unity, Research Institute, University, Poitiers, France
| | - Vendeuvre Tanguy
- A B S Lab, UFR Medicine and Pharmacy, Bat D1-Porte J 6, Milétrie Street, TSA 51115, 86073, Poitiers Cedex 9, France.,INSERM U1313-IRMETIST Unity, Research Institute, University, Poitiers, France
| | - Nguyen My-Van
- A B S Lab, UFR Medicine and Pharmacy, Bat D1-Porte J 6, Milétrie Street, TSA 51115, 86073, Poitiers Cedex 9, France
| | - Renault Arthur
- A B S Lab, UFR Medicine and Pharmacy, Bat D1-Porte J 6, Milétrie Street, TSA 51115, 86073, Poitiers Cedex 9, France
| | - Richer Jean-Pierre
- A B S Lab, UFR Medicine and Pharmacy, Bat D1-Porte J 6, Milétrie Street, TSA 51115, 86073, Poitiers Cedex 9, France.,INSERM U1313-IRMETIST Unity, Research Institute, University, Poitiers, France
| | - Hauet Thierry
- INSERM U1313-IRMETIST Unity, Research Institute, University, Poitiers, France
| | - Breque Cyril
- A B S Lab, UFR Medicine and Pharmacy, Bat D1-Porte J 6, Milétrie Street, TSA 51115, 86073, Poitiers Cedex 9, France
| | - Faure Jean-Pierre
- A B S Lab, UFR Medicine and Pharmacy, Bat D1-Porte J 6, Milétrie Street, TSA 51115, 86073, Poitiers Cedex 9, France.,INSERM U1313-IRMETIST Unity, Research Institute, University, Poitiers, France
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A new approach to enter Retzius space in laparoscopic transabdominal preperitoneal bilateral inguinal hernia repair. BMC Surg 2023; 23:26. [PMID: 36710336 PMCID: PMC9885556 DOI: 10.1186/s12893-023-01917-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2022] [Accepted: 01/16/2023] [Indexed: 01/31/2023] Open
Abstract
BACKGROUND To investigate the feasibility, safety and efficacy of the right-side approach to enter Retzius space in laparoscopic transabdominal preperitoneal bilateral inguinal hernia repair. METHODS Retrospective analysis was performed on 189 patients who were diagnosed with bilateral inguinal hernia preoperatively or intraoperatively and underwent selective TAPP in the General Surgery I Section of Shaanxi Provincial People's Hospital from January 2015 to September 2020. 94 cases were performed using the right-side approach (research group), and 95 cases with conventional approach (control group). Intraoperative and postoperative conditions of the two groups were observed and compared. RESULTS All operation were completed successfully. The operative time of research group was significantly shorter than that of control group (128.8 ± 35.4 vs 144.1 ± 40.9 min, P = 0.006). There were no significant differences in postoperative hospital stay, VAS score on first postoperative day, incidence of seroma and hematoma, urinary retention and other complications (P > 0.05). None of the patients occured hernia recurrence, mesh infection, intestinal obstruction and other complications. CONCLUSIONS The right-side approach to enter Retzius space is safe and feasible in TAPP surgery of bilateral inguinal hernia. Compared with the conventional approach, it can shorten the operative time and has certain advantages.
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12
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The Corona mortis is similar in size to the regular obturator artery, but is highly variable at the level of origin: an anatomical study. Anat Sci Int 2023; 98:43-53. [PMID: 35653059 PMCID: PMC9845159 DOI: 10.1007/s12565-022-00671-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Accepted: 05/11/2022] [Indexed: 02/01/2023]
Abstract
An enlarged anastomosis connecting the vascular territory of the external iliac and the obturator artery may replace most or all of the latter. This relatively common vascular variation, known as Corona mortis, can lead to death in the worst-case scenario if injured. Despite being well-known, exact anthropometric data are lacking. The purpose of this study was to determine diameters of the regular obturator artery, the Corona mortis and the inferior epigastric artery. In addition, the level of origin of the Corona mortis was quantified. The obturator artery and its norm variants were dissected bilaterally in 75 specimens (37 females, 38 males) and measured using two different methods. The Corona mortis was present in 36 of the 150 hemipelves (24%), presenting in one third of all cases bilaterally. Its level of origin measured from the commencement of the inferior epigastric artery was subject to high variability (4.4-28.3 mm). The mean diameters of the Corona mortis (mean 2.5 and 2.1 mm, respectively) and the regular obturator artery (mean 2.4 and 2.0 mm, respectively) were similar for both methods. There were no significant sex nor side differences. The diameter of the inferior epigastric artery was significantly smaller distal to the origin of the Corona mortis. The high incidence, non-predictable level of origin of the Corona mortis and its size similar to the regular obturator artery support its clinical relevance even to date. Clinicians should always be aware of an additional arterial vessel close to the pelvic brim.
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Keddie D, Abdulrehman Y, Shiau G. Reporting lower extremity CT angiography for treatment planning. Diagn Interv Imaging 2022; 103:387-393. [PMID: 35843841 DOI: 10.1016/j.diii.2022.06.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Revised: 06/17/2022] [Accepted: 06/24/2022] [Indexed: 11/03/2022]
Abstract
Diagnostic radiologists play an important role in the evaluation of patients presenting with signs and symptoms of lower extremity peripheral vascular disease, including critical limb ischemia in both acute and chronic settings, and intermittent claudication. The complications associated with tissue and/or limb loss related to acute limb ischemia and critical limb ischemia of the lower extremity make rapid diagnosis and early intervention critical in the management of these patients. Computed tomography angiography (CTA) is an effective, widely available, easily reproducible, non-invasive imaging modality that offers a rapid and accurate means to diagnose and grade the extent of vascular disease. However, CTA run-off reports are usually dictated in free text form, and referring and treating physicians may be unsure whether an anatomic structure has been evaluated if it has not been specifically mentioned in the report. In this article, the vascular anatomy and anatomic variants of the lower extremity, the most common lower extremity vascular pathologies are reviewed and clinically important CTA imaging findings are outlined. This provides a framework for radiologists to accurately evaluate lower extremity vascular pathologies and convey clinically relevant imaging findings for management by vascular surgeons or interventional radiologists.
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Affiliation(s)
- Danae Keddie
- Faculty of Medicine and Dentistry, Walter C Mackenzie Health Sciences Center, University of Alberta, Edmonton, Alberta, T6G 2B7, Canada.
| | - Yaasin Abdulrehman
- Faculty of Medicine and Dentistry, Walter C Mackenzie Health Sciences Center, University of Alberta, Edmonton, Alberta, T6G 2B7, Canada; Department of Surgery, Walter C Mackenzie Health Sciences Center, University of Alberta, Edmonton, Alberta, T6G 2B7, Canada
| | - Gillian Shiau
- Faculty of Medicine and Dentistry, Walter C Mackenzie Health Sciences Center, University of Alberta, Edmonton, Alberta, T6G 2B7, Canada; Radiology and Diagnostic Imaging Department, Walter C Mackenzie Health Sciences Center, University of Alberta, Edmonton, Alberta, T6G 2B7, Canada
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Dawod MS, Alisi MS, Rabab’a H, Abdulelah AA, Almaaitah HW, Haddad B. Surgical Management of Aneurysmal Bone Cyst of the Pubis: A Case Report and Review of Literature. Int Med Case Rep J 2022; 15:287-292. [PMID: 35726264 PMCID: PMC9206452 DOI: 10.2147/imcrj.s369073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Accepted: 05/31/2022] [Indexed: 11/23/2022] Open
Abstract
Introduction Case Report Conclusion
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Affiliation(s)
- Mohd Said Dawod
- Department of Special Surgery, Division of Orthopaedics, School of Medicine, Mutah University, Al Karak, Jordan
| | - Mohammed S Alisi
- Department of Special Surgery, Division of Orthopaedics, School of Medicine, The University of Jordan, Amman, Jordan
- Faculty of Medicine, Islamic University of Gaza, Gaza, Palestine
- Correspondence: Mohammed S Alisi, The University of Jordan, School of Medicine, Queen Rania Al Abdullah St 266 Al Jubaiha, Amman, 11942, Jordan, Tel +962790983284, Email
| | - Hammam Rabab’a
- School of Medicine, The University of Jordan, Amman, Jordan
| | | | | | - Bassem Haddad
- Department of Special Surgery, Division of Orthopaedics, School of Medicine, The University of Jordan, Amman, Jordan
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Molinero Montes M, Fernández Álvarez C, Fernández-Valdés Fernández J. [Translated article] Study of hemodynamic instability due to intrapelvic hemorrhage as a consequence of ilioischiopubian branch fractures in geriatric patients. Rev Esp Cir Ortop Traumatol (Engl Ed) 2022. [DOI: 10.1016/j.recot.2022.02.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
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Post-surgical pseudoaneurysm of the corona mortis artery treated by arterial embolization from two arteries: A case report. Radiol Case Rep 2022; 17:1132-1135. [PMID: 35169415 PMCID: PMC8829527 DOI: 10.1016/j.radcr.2022.01.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Accepted: 01/15/2022] [Indexed: 12/02/2022] Open
Abstract
Post-surgical pseudoaneurysm in the pelvis is rare. However, when it does occur, it may cause life-threatening hemorrhage. Hemostatic treatment for pelvic pseudoaneurysms may be complicated because the blood vessels in the pelvis may present with various anastomoses. Herein, we describe a case of a pseudoaneurysm that necessitated embolization of two arteries. A 47-year-old woman had undergone a total hysterectomy, a bilateral adnexectomy, and a pelvic lymphadenectomy for endometrial cancer; 13 days after surgery, she complained of sudden abdominal pain. Contrast-enhanced computed tomography revealed a retroperitoneal hematoma and a pseudoaneurysm with contrast leakage. The pseudoaneurysm had two feeding arteries (from the external and internal iliac systems). The first feeding artery was the obturator artery, which arose from the anterior trunk of the internal iliac artery. The second feeding artery was the aberrant obturator artery, which arose from the medial femoral circumflex artery. Both feeders were embolized and hemostasis was achieved. Pseudoaneurysms in the pelvis may have double origins from the external and internal iliac systems, and the aberrant obturator artery may arise from the medial femoral circumflex artery. Therefore, radiologists should be aware of these variations to effectively address post-surgical pseudoaneurysms of the corona mortis artery.
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Šaherl L, Rakuša M. An anatomical description of the obturator region with clinical aspects. J ANAT SOC INDIA 2022. [DOI: 10.4103/jasi.jasi_134_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Hu AW, McCarthy JJ, Breitenstein R, Uchtman M, Emery KH, Whitlock PW. The corona mortis: is it a rare and dangerous anomaly in adolescents undergoing periacteabular osteotomy? J Hip Preserv Surg 2021; 8:354-359. [PMID: 35505810 PMCID: PMC9052426 DOI: 10.1093/jhps/hnab079] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Revised: 08/07/2021] [Accepted: 12/28/2021] [Indexed: 01/18/2023] Open
Abstract
ABSTRACT
The corona mortis (CM) is a vascular connection between the obturator and external iliac or internal epigastric vessels that has historically been identified as a source of hemorrhage in pelvic surgery. However, its frequency, location, proximity to the osteotomies performed, vascular contributions and impact on blood loss in patients undergoing periacetabular osteotomy (PAO) are unknown. We sought to identify the frequency, origin, location relative to osteotomies performed during surgery and impact on blood loss of the CM. Preoperative magnetic resonance imaging (MRI) of the hips of 28 adolescent patients (56 hips) undergoing PAO was retrospectively reviewed for the presence of a CM. When identifiable, the size, nature (arterial or venous), orientation, position relative to the iliopectineal eminence (IPE) and associated estimated blood loss (EBL) were recorded. 75% (21/28) of patients possessed an identifiable, ipsilateral CM to the site of PAO, 90% of which were venous and 10% arterial. The vessel was typically 8.3 ± 3.8 mm medial and 11.1 ± 5.3 mm caudal from the anterosuperomedial edge of the IPE. There was no significant difference in the amount of EBL (519 ± 260 versus 694 ± 369 ml) or need for post-op transfusions (1/21 versus 0/7) between patients who possessed a CM and those who did not, respectively (P = 0.21). CM was more prevalent in this study than previously reported. However, the presence of an ipsilateral CM was not associated with an increase in EBL or transfusion during routine PAO surgery using modern surgical techniques.
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Affiliation(s)
- Alan W Hu
- Department of Internal Medicine, Mayo Clinic, 1216 2nd St SW, Rochester, MN 55905, USA
| | - James J McCarthy
- Department of Orthopaedic Surgery, Cincinnati Children’s Hospital Medical Center, 3333 Burnet Ave, Cincinnati, OH 45229, USA
| | - Rachel Breitenstein
- Department of Orthopaedic Surgery, Cincinnati Children’s Hospital Medical Center, 3333 Burnet Ave, Cincinnati, OH 45229, USA
| | - Molly Uchtman
- Department of Orthopaedic Surgery, Cincinnati Children’s Hospital Medical Center, 3333 Burnet Ave, Cincinnati, OH 45229, USA
| | - Kathleen H Emery
- Department of Radiology, Cincinnati Children’s Hospital Medical Center, 3333 Burnet Ave, Cincinnati, OH 45229, USA
| | - Patrick W Whitlock
- Department of Orthopaedic Surgery, Cincinnati Children’s Hospital Medical Center, 3333 Burnet Ave, Cincinnati, OH 45229, USA
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Variations in branching patterns of internal iliac artery according to Adachi's classification - Literature review and presentation of a case. TRANSLATIONAL RESEARCH IN ANATOMY 2021. [DOI: 10.1016/j.tria.2021.100119] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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Study of hemodynamic instability due to intrapelvic hemorrhage as a consequence of ilioischiopubian branch fractures in geriatric patients. Rev Esp Cir Ortop Traumatol (Engl Ed) 2021; 66:223-226. [PMID: 34148809 DOI: 10.1016/j.recot.2021.02.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Revised: 02/07/2021] [Accepted: 02/10/2021] [Indexed: 11/24/2022] Open
Abstract
INTRODUCTION Pelvic branch fractures are a common feature in old people which are usually treated conservatively. Massive hemorrhage is a strange complication that can compromise the patient's life. The objective of this study is to determine the incidence and possible risk factors of massive arterial injury in fractures of pelvic branches due to low energy trauma in patients over 65 years old. CLINICAL CASE Observational study of 142 patients diagnosed with pelvic branch fracture, We analyzed the age, sex, anatomical location, hemoglobin, need for hospital admission, complementary diagnostic test, complications and hospital stay. RESULTS All those ilioisquiopubial fractures complicated with massive bleeding (4 patients) were located in the Nakatani area I in close relationship with the obturator artery, internal pudendal artery and the Corona Mortis. All patients needed supraselective embolization for hemorrhagic control. Three of the patients were taking anticoagulants. DISCUSSION The 2,8% of patients with pelvic branch fractures may suffer a hemorrhagic complication. Be able to establish possible risk factors such a medication or anatomical location can help us identify these patients and carry out closer surveillance.
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Zou R, Wu M, Guan J, Xiao Y, Chen X. Clinical Results of Acetabular Fracture via the Pararectus versus Ilioinguinal Approach. Orthop Surg 2021; 13:1191-1195. [PMID: 33945221 PMCID: PMC8274146 DOI: 10.1111/os.12970] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Revised: 01/18/2021] [Accepted: 01/28/2021] [Indexed: 12/16/2022] Open
Abstract
Objective To compare the clinical efficacy of pararectus and ilioinguinal approach in the treatment of acetabular fractures. Methods A retrospective analysis of the clinical data of 60 patients with acetabular fractures treated by the pararectus approach or the ilioinguinal approach from January 2016 to January 2019 was performed to record all data by comparing the length of the surgical incision, the time to expose the fracture and the amount of blood loss during the operation. Patients were routinely followed up at 1, 6 and 12 months postoperatively. The function of the hip joint after the operation (Improved Merle d' Aubigne and Postel scores) and the complications postoperation were recorded. Results There was a significant difference (mean ± SD) in the length of surgical incision [(11.2 ± 1.5) cm vs.(23.8 ± 2.1) cm], and in surgical exposure time [(10.8 ± 1.7) min vs.(19.9 ± 1.9) min] (P < 0.05) between the two approaches; there was no significant difference (mean ± SD) in intraoperative blood loss [(591.8 ± 131.4) mL vs. (614.6 ± 132.7) mL] or in hip function scores at the last follow‐up between the two groups (P > 0.05). In the pararectus approach group, there was one patient (3.3%) with postoperative wound fat liquefaction, and the wound completely improved by secretion culture, enhanced dressing and effective antibiotics, one patient (3.3%) developed lateral femoral cutaneous nerve injury; One case (3.3%) of postoperative myositis ossificans occurred in the ilioinguinal approach group, and there were no obvious symptoms. Conclusions These data suggest that for patients with acetabular fractures, both the pararectus approach and the ilioinguinal approach can achieve satisfactory surgical results, but the former has relatively simple operation and small incision length, which is in line with the modern concept of the minimally invasive pelvis.
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Affiliation(s)
- Ruyi Zou
- Department of Orthopaedics, The First Affiliated Hospital of Bengbu Medical College, Bengbu, China
| | - Min Wu
- Department of Orthopaedics, The First Affiliated Hospital of Bengbu Medical College, Bengbu, China
| | - Jianzhong Guan
- Department of Orthopaedics, The First Affiliated Hospital of Bengbu Medical College, Bengbu, China
| | - Yuzhou Xiao
- Department of Orthopaedics, The First Affiliated Hospital of Bengbu Medical College, Bengbu, China
| | - Xiaotian Chen
- Department of Orthopaedics, The First Affiliated Hospital of Bengbu Medical College, Bengbu, China
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Qazi E, Wilting J, Patel NR, Alenezi AO, Kennedy SA, Tan KT, Jaberi A, Mafeld S. Arteries of the Lower Limb-Embryology, Variations, and Clinical Significance. Can Assoc Radiol J 2021; 73:259-270. [PMID: 33886403 DOI: 10.1177/08465371211003860] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVES The purpose of this article is to review the embryology of the lower limb arterial anatomy along with common variants and their clinical relevance. DESIGN Embryologic variations of the lower limb arterial system may be explained by i.) persistence of primordial arterial segments, ii.) abnormal fusion, iii.) segmental hypoplasia/absence, or a combination of both. Persistent sciatic artery, corona mortis, and popliteal entrapment syndrome will also be discussed with associated symptoms, and potential complications. CONCLUSION Knowledge of these variations is essential for surgical and endovascular management as failure to recognize them can result in complications.
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Affiliation(s)
- Emmad Qazi
- Department of Medical Imaging, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Joerg Wilting
- Department of Anatomy and Cell Biology, Georg-August-University Goettingen, Kreuzbergring, Germany
| | - Neeral R Patel
- Department of Medical Imaging, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Abdullah O Alenezi
- Department of Medical Imaging, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Sean A Kennedy
- Department of Medical Imaging, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Kong T Tan
- Department of Medical Imaging, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Arash Jaberi
- Department of Medical Imaging, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Sebastian Mafeld
- Department of Medical Imaging, University Health Network, University of Toronto, Toronto, Ontario, Canada
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Anatomical position of the corona mortis relative to the anteroposterior and inlet views. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2021; 32:341-345. [PMID: 33885982 DOI: 10.1007/s00590-021-02983-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Accepted: 04/12/2021] [Indexed: 10/21/2022]
Abstract
PURPOSE Although pubic ramus fractures are common in the elderly, resultant hemodynamic instability is a rare complication. The corona mortis, a vascular anastomosis between the obturator vessels and the external iliac vessels in the retropubic space, is occasionally damaged by fractures of the pubic ramus, causing significant hemorrhage. The purpose of this study was to evaluate the incidence and anatomical position of the corona mortis on the anteroposterior and inlet views. METHODS Sixty-one cadavers (122 hemipelvizes) were dissected and the incidence of the corona mortis was evaluated. Photographs were then taken simulating anteroposterior and inlet radiographs, and labeled as the anteroposterior and inlet views. The distance from the pubic symphysis to the corona mortis was measured on each of the two views. RESULTS The corona mortis was present in 76.1% of hemipelvizes. The corona mortis traverses along the periosteum of the dorsal surface of the pubis. The incidence of arterial corona mortis was 28.3% and that of venous corona mortis was 76.1%. The distance from the superior margin of the symphysis pubis to the corona mortis measured 47.7 ± 9.9 (45.9-49.6) mm on the anteroposterior view, and 59.4 ± 9.2 (57.3-61.5) mm on the inlet view. CONCLUSIONS In order to predict possible hemodynamic instability of the corona mortis following pubic ramus fractures, it is of clinical significance to precisely establish the anatomical position of the corona mortis on the anteroposterior and inlet views.
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Kostov S, Kornovski Y, Slavchev S, Ivanova Y, Dzhenkov D, Dimitrov N, Yordanov A. Pelvic Lymphadenectomy in Gynecologic Oncology-Significance of Anatomical Variations. Diagnostics (Basel) 2021; 11:diagnostics11010089. [PMID: 33430363 PMCID: PMC7825766 DOI: 10.3390/diagnostics11010089] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2020] [Revised: 01/03/2021] [Accepted: 01/05/2021] [Indexed: 01/15/2023] Open
Abstract
Pelvic lymphadenectomy is a common surgical procedure in gynecologic oncology. Pelvic lymph node dissection is performed for all types of gynecological malignancies to evaluate the extent of a disease and facilitate further treatment planning. Most studies examine the lymphatic spread, the prognostic, and therapeutic significance of the lymph nodes. However, there are very few studies describing the possible surgical approaches and the anatomical variations. Moreover, a correlation between anatomical variations and lymphadenectomy in the pelvic region has never been discussed in medical literature. The present article aims to expand the limited knowledge of the anatomical variations in the pelvis. Anatomical variations of the ureters, pelvic vessels, and nerves and their significance to pelvic lymphadenectomy are summarized, explained, and illustrated. Surgeons should be familiar with pelvic anatomy and its variations to safely perform a pelvic lymphadenectomy. Learning the proper lymphadenectomy technique relating to anatomical landmarks and variations may decrease morbidity and mortality. Furthermore, accurate description and analysis of the majority of pelvic anatomical variations may impact not only gynecological surgery, but also spinal surgery, urology, and orthopedics.
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Affiliation(s)
- Stoyan Kostov
- Department of Gynecology, Medical University Varna “Prof. Dr. Paraskev Stoyanov”, 9002 Varna, Bulgaria; (S.K.); (Y.K.); (S.S.); (Y.I.)
| | - Yavor Kornovski
- Department of Gynecology, Medical University Varna “Prof. Dr. Paraskev Stoyanov”, 9002 Varna, Bulgaria; (S.K.); (Y.K.); (S.S.); (Y.I.)
| | - Stanislav Slavchev
- Department of Gynecology, Medical University Varna “Prof. Dr. Paraskev Stoyanov”, 9002 Varna, Bulgaria; (S.K.); (Y.K.); (S.S.); (Y.I.)
| | - Yonka Ivanova
- Department of Gynecology, Medical University Varna “Prof. Dr. Paraskev Stoyanov”, 9002 Varna, Bulgaria; (S.K.); (Y.K.); (S.S.); (Y.I.)
| | - Deyan Dzhenkov
- Department of General and Clinical Pathology, Forensic Medicine and Deontology, Division of General and Clinical Pathology, Faculty of Medicine, Medical University Varna “Prof. Dr. Paraskev Stoyanov”, 9002 Varna, Bulgaria;
| | - Nikolay Dimitrov
- Department of Anatomy, Faculty of Medicine, Trakia University, 6000 Stara Zagora, Bulgaria;
| | - Angel Yordanov
- Department of Gynecologic Oncology, Medical University Pleven, 5800 Pleven, Bulgaria
- Correspondence:
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Sarasammal S, Thampi S, Oommen A, Rajasekharan S. Anatomical variants of the obturator artery and their clinical importance. INDIAN JOURNAL OF VASCULAR AND ENDOVASCULAR SURGERY 2021. [DOI: 10.4103/ijves.ijves_31_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Cardoso GI, Chinelatto LA, Hojaij F, Akamatsu FE, Jacomo AL. Corona Mortis: A Systematic Review of Literature. Clinics (Sao Paulo) 2021; 76:e2182. [PMID: 33886786 PMCID: PMC8024925 DOI: 10.6061/clinics/2021/e2182] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Accepted: 03/02/2021] [Indexed: 11/26/2022] Open
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.
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Affiliation(s)
| | | | - Flavio Hojaij
- Departamento de Cirurgia, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, SP, BR
| | - Flávia Emi Akamatsu
- Departamento de Cirurgia, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, SP, BR
| | - Alfredo Luiz Jacomo
- Departamento de Cirurgia, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, SP, BR
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Risk of Injury to the Neurovascular Structures in the Pararectus Approach Used in Acetabular Fractures: A Cadaver Study. J Orthop Trauma 2021; 35:e13-e17. [PMID: 32502059 DOI: 10.1097/bot.0000000000001856] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/29/2020] [Indexed: 02/02/2023]
Abstract
OBJECTIVES Complex acetabular fractures involving the quadrilateral plate may necessitate infrapectineal buttress plating, which can be performed through the pararectus approach. The aim of this cadaveric study was to identify the anatomical guide points to protect neurovascular structures at the risk of injury during the pararectus approach. METHODS Six fresh frozen cadavers (12 hemipelves) were dissected in this study. Location of the inferior epigastric artery (IEA), obturator nerve and corona mortis (CM) was measured using common anatomic landmarks, namely, anterior superior iliac spine, symphysis pubis (SP), and sacroiliac (SI) joint. RESULTS In the superficial dissection of the abdominal wall, the mean distance between the IEA and anterior superior iliac spine was 106.7 ± 5.2 (range, 99.2-116.4) mm, and the mean distance between IEA and SP was 77.9 ± 3.5 (range, 70.6-82.2) mm. In deep dissection, the mean distance between the SI joint and the SP was 133.1 ± 5.7 (range, 126.0-142.0) mm. The mean distance between the SI joint and ON was 37.3 ± 2.8 (range, 31.0-41.0) mm. The CM was unable to be detected in 2 cadavers, 1 on the right and 1 on the left hemipelves. The mean distance between the CM and SP was 47.7 ± 3.9 (range, 43.0-55.0) mm. CONCLUSIONS A pararectus approach is a useful approach which allows infrapectineal plating in the treatment of complex acetabular fractures; however, the preservation of critical neurovascular structures is essential during dissection. This study is helpful to identify the structures at risk according to commonly used anatomic landmarks. These data might be a necessary guideline for hip and trauma surgeons.
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The arterial blood supply of the symphysis pubis - Spatial orientated and highly variable. Ann Anat 2020; 234:151649. [PMID: 33227373 DOI: 10.1016/j.aanat.2020.151649] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Revised: 10/19/2020] [Accepted: 11/02/2020] [Indexed: 11/21/2022]
Abstract
BACKGROUND Open surgical treatment of the pubic region and adductor related pathologies require an exact knowledge of the arterial blood supply of the symphysis pubis that seems furthermore important to explain the hematogenous occurrence of symphysitis. Pubic bone marrow oedema (PBME) is a frequent occurring magnetic resonance imaging finding in groin pain. However, even asymptomatic athletes present PBME and a correlation to the physical activity or higher blood flow was suggested. Data on the vascular anatomy of the symphysis pubis are rare. METHODS Ten formaldehyde-embalmed cadavers were dissected, and the arterial blood supply was investigated and photographically documented. RESULTS In the majority of cases the following pattern was determined: superior-inferior epigastric artery (n=12 hemipelves), inferior - dorsal artery of the penis/dorsal artery of the clitoris (n=16), posterior- obturator artery (n=16 hemipelves), anterior- deep external pudendal artery (n=14 hemipelves). Besides variations for the deep external pudendal artery anteriorly, we observed a highly variable arterial supply, especially superior. Superior in 4/10 cadavers, inferior in 0/10 cadavers, posterior in 2/10 cadavers and anterior in 5/10 cadavers side variations were found. CONCLUSION The symphysis pubis has a spatial and rich organized arterial blood supply with several variations. Despite the symphysis pubis is recognized as bradytroph, the high number of vessels is presumably required in stress situations for example in heavy training.
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Zou R, Wu M, Guan J, Xiao Y, Chen X. Therapeutic Effect of Acetabular Fractures Using the Pararectus Approach Combined with 3D Printing Technique. Orthop Surg 2020; 12:1854-1858. [PMID: 33112031 PMCID: PMC7767683 DOI: 10.1111/os.12738] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2020] [Revised: 05/09/2020] [Accepted: 06/03/2020] [Indexed: 11/28/2022] Open
Abstract
Objective To explore the clinical efficacy of pararectus approach combined with 3D printing technique for the surgical treatment of partial acetabular fractures. Methods We retrospectively evaluated 33 (20 males and 13 females) patients with acetabular fractures in the period of June 2017 to December 2018. According to Judet and Letournel classification: 11 cases were of anterior column fracture, 10 cases were of double column fracture, seven fractures were of the anterior column with posterior half transverse, three fractures were of transverse fracture, and two cases were of “T” fracture. For all cases, 3D printing is used to print the acetabular model. Pre‐bent reconstruction plates from the model were placed to fixate fractures via the pararectus approach. Results Thirty‐three patients (mean age 48 years; range, 35–63 years), included 20 men and 13 women, were treated successfully with open reduction and internal fixation by the pararectus approach. Surgery duration was 203 min on average (range: 135–245 min), and intra‐operative bleeding was 1030 mL on average (range: 450–1400 mL). All patients were followed‐up for 12–18 months (average,14 months); two patients (6.0%) developed postoperative ossifying myositis, and there are no obvious symptoms at present; one patient (3.0%) developed postoperative wound infection, and the wound completely improved by secretion culture, enhanced dressing, and effective antibiotics; all the acetabular fractures united after 12 to 16 weeks (average,13 weeks). According to the modified Merle d'Aubigne and Postel scoring system to assess the hip function: excellent in 22 cases (66.7%), good in seven cases (21.2%), and fair in four cases (12.1%). Conclusions In the treatment of partial acetabular fractures, the pararectus approach combined with 3D printing technique can achieve effective reduction and fixation, decrease intraoperative hemorrhage, shorten operation time, and the internal fixation position can be properly adjusted during the operation by looking directly at the model.
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Affiliation(s)
- Ruyi Zou
- Department of Orthopaedics, The First Affiliated Hospital of Bengbu Medical College, Bengbu, China
| | - Min Wu
- Department of Orthopaedics, The First Affiliated Hospital of Bengbu Medical College, Bengbu, China
| | - Jianzhong Guan
- Department of Orthopaedics, The First Affiliated Hospital of Bengbu Medical College, Bengbu, China
| | - Yuzhou Xiao
- Department of Orthopaedics, The First Affiliated Hospital of Bengbu Medical College, Bengbu, China
| | - Xiaotian Chen
- Department of Orthopaedics, The First Affiliated Hospital of Bengbu Medical College, Bengbu, China
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Muñoz KDR, Powers JM, Zhang S, Kale SS. Prevalence and Utilization of Obturator Artery Anatomic Variant in Autologous Breast Reconstruction. J Reconstr Microsurg 2020; 37:256-262. [PMID: 33032357 DOI: 10.1055/s-0040-1717153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
BACKGROUND The objective of this study is to quantify the prevalence and describe the utilization of an anatomic vascular variant in which the obturator artery (OA) arises from the trunk of the deep inferior epigastric artery (DIEA) in stacked/dual-pedicled autologous breast reconstruction. When this variant is identified preoperatively on computed tomography angiography (CTA), it may be utilized in a "flow-through" fashion to direct antegrade internal mammary artery (IMA) flow into a second free flap to facilitate anastomotic arrangement and optimize perfusion. METHODS Preoperatively obtained abdomen/pelvis CTA imaging of 121 autologous breast reconstruction patients were retrospectively reviewed for the unilateral or bilateral presence of the OA branch arising from the DIEA (OA variant). The results were analyzed using descriptive statistics. RESULTS Our analysis revealed the presence of the OA variant in 60 of the 121 (49.6%) breast reconstruction candidates, either unilaterally or bilaterally. Out of these patients, the variant was present unilaterally in 33 (55%) and bilaterally in 27 (45%) patients. Of the unilateral variants, 12 (36.4%) patients demonstrated right-sided laterality, while 21 (63.6%) patients demonstrated left-sided laterality. Clinically, this anatomic variant has been utilized in several cases of autologous breast reconstruction with flap survival in all cases. CONCLUSION Utilization of this anatomic variant in stacked or dual-pedicled autologous breast reconstruction results in antegrade IMA perfusion of both primary and secondary flaps, as well as improved size match compared with other anastomotic options. Knowledge of the vascular anatomy and variations in the inferior epigastric system is crucial to both preventing complications and optimizing flap planning and outcome.
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Affiliation(s)
| | - Jeremy M Powers
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Virginia Commonwealth University Health, Richmond, Virginia
| | - Shuhao Zhang
- Department of Plastic Surgery, Mercy Medical Group, Sacramento, California
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Bhoil R, Aggarwal N, Aggarwal V, Surya M, Sharma S, Ahluwalia A, Bhoil S, Singh SP, Thakur M, Sood S. "Crown of Death"; Corona Mortis, a Common Vascular Variant in Pelvis: Identification at Routine 64-Slice CT-Angiography. Bull Emerg Trauma 2020; 8:193-198. [PMID: 32944580 PMCID: PMC7468229 DOI: 10.30476/beat.2020.84118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Objective: To establish the incidence of arterial corona mortis variant in angiographic studies being performed using a 64 slice CT scan machine in a series of patients. Methods: This was a prospective cross-sectional study including 100 consecutive patients undergoing routine clinically indicated, standard protocol, CT-angiography for the abdominal aorta and/or lower limbs using a 64 slice CT scanner. Patients having severe arterial insufficiency (Grade 4 stenosis on CT angiography), pelvic infections and tumours, patients with past pelvic trauma and those who had previous pelvic surgery were excluded from the study. In total 200 hemi-pelvises were evaluated for the presence or absence of corona morti. Results: Overall, we included 100 patients in this series including 67 men and 33 women with mean age of 40.1±2.3 (ranging from 22-74) years. The arterial variant was identified on thin, 0.625-mm-thick images in 24 out of 100 patients studied (unilateral in 20 patients and bilateral in 4 patients; 28 out of 200 hemipelvises evaluated, having an incidence of 14%). We found that the distance of corona mortis artery from the symphysis was significantly greater for women compared to men, both on right (p=0.034) and left sides (p=0.046). Conclusion: Corona mortis may be prospectively identified at contrast-enhanced multidetector CT especially in pelvic trauma patients and help guide subsequent endovascular embolization or surgical interventions.
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Affiliation(s)
- Rohit Bhoil
- Department of Radiodiagnosis, IGMC Shimla, India
| | | | | | - Mukesh Surya
- Department of Radiodiagnosis, IGMC Shimla, India
| | | | | | - Sabina Bhoil
- Department of Cardiac Anesthesia, IGMC Shimla, India
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Gupta AK, Burgos MI, Santiago Rodriguez AJ, Lopez-Viego M, Ramseyer MM. Major Bleed Post Minimally Invasive Surgical Repair of Inguinal Hernia. Cureus 2020; 12:e9940. [PMID: 32968600 PMCID: PMC7505676 DOI: 10.7759/cureus.9940] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
At our center, over 200 patients undergo minimally invasive repairs of inguinal hernias every year using a laparoscope and a robotic-assisted technique. In three patients who underwent a minimally invasive procedure for uncomplicated indirect inguinal hernia, the postoperative course was complicated with bleeding and required an exploratory laparotomy. Post-procedure, the patients developed tachycardia and hypotension with a drop in hemoglobin, for which the patients required surgical re-exploration in an emergent fashion. The factors leading to bleeding were analyzed and are reported herein to increase awareness and prevent the occurrence of these complications during inguinal hernia surgery.
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Affiliation(s)
- Anupam K Gupta
- Minimally Invasive Surgery, University of Miami Hospital, Miami, USA
| | - Monica I Burgos
- Internal Medicine, Universidad Autonoma de Guadalajara, Guadalajara, MEX
| | | | - Miguel Lopez-Viego
- Surgery, Bethesda Hospital East, Boca Raton, USA.,Surgery, Bethesda Hospital, Boynton Beach, USA
| | - Matthew M Ramseyer
- Trauma and Critical Care Surgery, Florida State University Collage of Medicine, Palm Beach, USA
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Frequency and Clinical Review of the Aberrant Obturator Artery: A Cadaveric Study. Diagnostics (Basel) 2020; 10:diagnostics10080546. [PMID: 32751771 PMCID: PMC7459979 DOI: 10.3390/diagnostics10080546] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Revised: 07/12/2020] [Accepted: 07/29/2020] [Indexed: 11/20/2022] Open
Abstract
The occurrence of an aberrant obturator artery is common in human anatomy. Detailed knowledge of this anatomical variation is important for the outcome of pelvic and groin surgeries requiring appropriate ligation. Familiarity with the occurrence of an aberrant obturator artery is equally important for instructors teaching pelvic anatomy to students. Case studies highlighting this vascular variation provide anatomical instructors and surgeons with accurate information on how to identify such variants and their prevalence. Seven out of eighteen individuals studied (38.9%) exhibited an aberrant obturator artery, with two of those individuals presenting with bilateral aberrant obturator arteries (11.1%). Six of these individuals had an aberrant obturator artery that originated from the deep inferior epigastric artery (33.3%). One individual had an aberrant obturator artery that originated directly from the external iliac artery (5.6%).
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Pulatoğlu Ç, Doğan O, Medisoğlu MS, Yassa M, Ellibeş Kaya A, Selçuk İ, Bayık RN. Surgical anatomy of the pectineal ligament during pectopexy surgery: The relevance to the major vascular structures. Turk J Obstet Gynecol 2020; 17:21-27. [PMID: 32341826 PMCID: PMC7171544 DOI: 10.4274/tjod.galenos.2020.21284] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2020] [Accepted: 02/27/2020] [Indexed: 12/01/2022] Open
Abstract
Objective: During pectopexy surgery, the prolapsed uterus or the vaginal apex is fixed to the pectineal ligament. The anatomic structures found in the lateral part of the prevesical and paravaginal space above the obturator fossa, raise the importance of the surgical steps required to prevent complications. This study was conducted to evaluate the proximity of vascular structures to the pectineal ligament. Materials and Methods: The distances between the surgical suturing area during pectopexy surgery and the external iliac vein, pubic anastomotic vessel (corona mortis) and obturator canal were measured bilaterally in seven fresh female cadavers. Results: The total length of the pectineal ligament was 5.9±0.76 cm on the left and 6.5±1.14 cm on the right side; the midpoint of the pectineal ligament was 2.8±0.52 cm on the left and 3.6±0.47 cm on the right side. From the midpoint of the left pectineal ligament, the mean distance to the left external iliac vein was 1.04±0.23 cm, to the left corona mortis it was 2.15±0.48 cm, and to the left obturator canal it was 3.12±0.95 cm. From the midpoint of the right pectineal ligament, the mean distance to the right external iliac vein was 1.25±0.43 cm, to the right corona mortis it was 2.37±0.63 cm, and to the right obturator canal it was 3.57±0.93 cm. Conclusion: The anatomic findings of the study confirmed that the pectineal ligament was in close association with main vessels. The external iliac vein was measured as the closest anatomic structure to the pectineal ligament. Surgeons must be careful to minimize life-threatening complications because of the proximity of the pectineal ligament to main vessels.
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Affiliation(s)
- Çiğdem Pulatoğlu
- İstinye University Hospital Gaziosmanpaşa Medical Park, Clinic of Obstetrics and Gynecology, İstanbul, Turkey
| | - Ozan Doğan
- Private Clinic, Clinic of Obstetrics and Gynecology, İstanbul, Turkey
| | | | - Murat Yassa
- Sancaktepe Şehit Professor İlhan Varank Training and Research Hospital, Clinic of Obstetrics and Gynecology, İstanbul, Turkey
| | - Aşkı Ellibeş Kaya
- Düzce University Hospital, Clinic of Obstetrics and Gynecology, Düzce, Turkey
| | - İlker Selçuk
- University of Health Sciences Turkey, Ankara Bilkent City Hospital, Clinic of Gynecologic Oncology/Hacettepe University Faculty of Medicine, Department of Anatomy, Ankara, Turkey
| | - Rahime Nida Bayık
- University of Health Sciences Turkey, Göztepe Training and Research Hospital, Clinic of Obstetrics and Gynecology, İstanbul, Turkey
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Han J, Shah M, Djaladat H, Aron M. Corona Mortis Artery Pseudoaneurysm Causing Delayed Intermittent Hemoperitoneum After Robotic Radical Prostatectomy. Urology 2020; 141:e24-e25. [PMID: 32330530 DOI: 10.1016/j.urology.2020.04.017] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2020] [Accepted: 04/05/2020] [Indexed: 11/27/2022]
Abstract
Pseudoaneurysms are rare in urology and typically have a delayed presention with intermittent episodes of bleeding. We report a patient who presented with delayed and recurent hemoperitoneum following robotic assisted laparoscopic salvage radical prostatectomy and was found to have a pseudoaneurysm in the corona mortis artery.
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Affiliation(s)
- Jullet Han
- USC Institute of Urology, University of Southern California, 1441 Eastlake Avenue, Suite 7416, Los Angeles, CA 90089
| | - Mihir Shah
- USC Institute of Urology, University of Southern California, 1441 Eastlake Avenue, Suite 7416, Los Angeles, CA 90089
| | - Hooman Djaladat
- USC Institute of Urology, University of Southern California, 1441 Eastlake Avenue, Suite 7416, Los Angeles, CA 90089
| | - Monish Aron
- USC Institute of Urology, University of Southern California, 1441 Eastlake Avenue, Suite 7416, Los Angeles, CA 90089
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36
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Du MM, Wang AG, Shi XH, Zhao B, Liu M. Safety Precautions for the Corona Mortis using Minimally Invasive Ilioinguinal Approach in Treatment of Anterior Pelvic Ring Fracture. Orthop Surg 2020; 12:957-963. [PMID: 32291959 PMCID: PMC7307238 DOI: 10.1111/os.12679] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2019] [Revised: 02/24/2020] [Accepted: 03/18/2020] [Indexed: 11/27/2022] Open
Abstract
Objective To explore the safety of the corona mortis of the minimally invasive plate insertion in treatment of the anterior pelvic ring fracture by studying the relationship between the vessel and the position of plate. Method The corona mortis was dissected out of eight adult cadavers and were simulated for the insertion of the anterior ring minimally invasive plate, and the presence of the anastomotic branch (the corona mortis) in the suprapubic branch area was observed. After the Corona mortis stripped off, the data was measured, such as the length, vessel diameter, distance from the pubic tubercle, and the maximum vertical distance between the corona mortis and the pubis. The measured data and the previous literatures were analyzed to study the morphology of the corona mortis and the position relation between the corona mortis and the placement of subperiosteal tunnel through the minimally invasive ilioinguinal approach. Results Out of the 16 unilateral pelvises, the corona mortis were observed on 12 unilateral pelvises with an incidence rate of 75%. Amongst them, there were seven cases of vein anastomosis (incidence of 43.75%), three cases of arterial anastomosis (incidence of 18.75%), and two cases of both arterial anastomosis and vein anastomosis (incidence of 12.5%). The corona mortis length ranged between 24.5 and 37.5 mm (average of 30.7 ± 3.6 mm); the diameter ranged between 1.6 and 3.5 mm (average of 2.5 ± 0.5 mm) and the distance between the vessels and the pubic tubercle was between 53.9 and 65.2 mm (average of 59.0 ± 3.6 mm). Above the pubis, the corona mortis originated from the iliac or the inferior epigastric vessel. It crossed the pubic branch to the dorsal side of the pubis and proceeded downward to anastomize with the obturator vessels near the obturator. Toothless tweezers were used to peel and lift up the corona mortis from the pubic bone. The maximum vertical distance between the corona mortis and the pubis ranged between 8.8 and 18.3 mm (average of 12.6 ± 3.0 mm). Conclusion The corona mortis have a high rate of incidence, with a large number of differences in the type and shape of blood vessels among patients. Following peeling, the movement between the corona mortis and pubic bone is limited. Nevertheless, the plate and bone exfoliator still passed safely. Therefore, when surgeons use the minimally invasive ilioinguinal approach to establish channels, the process of subperiosteal stripping must be performed to avoid any accidental injury.
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Affiliation(s)
- Meng-Meng Du
- First Clinical Medical College, Shandong University of Traditional Chinese Medicine, Jinan, China
| | - Ai-Guo Wang
- Department of Trauma Orthopaedics, Zhengzhou Orthopaedic Hospital, Zhengzhou, China
| | - Xiao-Hua Shi
- Department of Trauma Orthopaedics, Zhengzhou Orthopaedic Hospital, Zhengzhou, China
| | - Bo Zhao
- Department of Peripheral Blood Vessel, The Affiliated Hospital of Shandong University of Traditional Chinese Medicine, Jinan, China
| | - Ming Liu
- Department of Peripheral Blood Vessel, The Affiliated Hospital of Shandong University of Traditional Chinese Medicine, Jinan, China
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Noussios G, Galanis N, Chatzis I, Konstantinidis S, Filo E, Karavasilis G, Katsourakis A. The Anatomical Characteristics of Corona Mortis: A Systematic Review of the Literature and Its Clinical Importance in Hernia Repair. J Clin Med Res 2020; 12:108-114. [PMID: 32095180 PMCID: PMC7011932 DOI: 10.14740/jocmr4062] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2019] [Accepted: 01/06/2020] [Indexed: 11/11/2022] Open
Abstract
Background Inguinal hernia repair is one of the most common daily operations in general surgery. However, the anatomical structures of the region, such as the corona mortis (the crown of death), make this procedure quite challenging. A comprehensive knowledge of its anatomy is essential, since massive hemorrhage may occur if the vessel is injured. The current review of the literature aimed to report the frequency and anatomical variations of vascular corona mortis. Methods A substantial study was coordinated through PubMed, Scopus and Google Scholar. The Prisma guidelines were used for the systematic review of the articles found. A total of 13 studies and 1,455 patients were included for the statistical analysis. Results The results showed that corona mortis was present in about half the hemi-pelvises, and to be more accurate, the prevalence was 46%. Venous corona mortis was more frequent than the arterial type (42% vs. 25%). Conclusions Considering the percentages mentioned above, every surgeon who schedules an operation on the retro-pubic area, especially during a hernioplasty procedure, should evaluate the possibility of the presence of corona mortis. Anatomical knowledge of the region is vital for attempting to eliminate the risk of injuring the corona mortis during surgery.
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Affiliation(s)
- George Noussios
- School of Physical Education and Sports Sciences of Serres, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Nikiforos Galanis
- School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Iosif Chatzis
- Department of General Surgery, Agios Dimitrios General Hospital, Thessaloniki, Greece
| | | | - Eva Filo
- Department of General Surgery, Agios Dimitrios General Hospital, Thessaloniki, Greece
| | - George Karavasilis
- Department of Business Administration, Technological Educational Institute of Central Macedonia, Serres, Greece
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Nayak T, Mittal S, Trikha V, Farooque K, Gamanagatti S, Sharma V. Short-term results of surgical treatment of acetabular fractures using the modified Stoppa approach. J Clin Orthop Trauma 2020; 11:1121-1127. [PMID: 33192018 PMCID: PMC7656521 DOI: 10.1016/j.jcot.2020.10.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2020] [Revised: 10/07/2020] [Accepted: 10/07/2020] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND As the more commonly used ilioinguinal approach is extensive and associated with complications arising from the dissection along the inguinal canal, we attempt to evaluate the efficacy of the modified Stoppa approach as an alternative in the operative management of acetabular fractures. METHODS Twenty-three patients with acetabular fractures, were operated by the modified Stoppa approach. Fractures were classified; operative time and blood loss were recorded; the radiological and clinical outcomes were prospectively analysed. We analysed the radiological results according to the criteria of Matta and the clinical results by the Merle d'Aubigne and Postel score with a mean follow up of 15.13 months. RESULTS The clinical outcomes were excellent or good in nineteen cases, fair and poor in two patients each. In eighteen of our cases the reduction was anatomic, imperfect in two cases, and poor in three cases. The mean pre-operative displacements on axial, sagittal and coronal NCCT sections were 3.8, 3.1 and 3.6 mm, respectively; and mean post-operative displacements were 0.2, 0.3 and 0.2 mm, respectively. The mean pre-operative and post-operative fracture gap were 12.8 mm and 1.1 mm respectively. CONCLUSIONS Minimizing perioperative morbidity and simultaneously allowing access for anatomical reduction are the major benefits of the approach. The modified Stoppa approach can substitute the ilioinguinal approach for the surgical fixation of acetabular fractures.
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Affiliation(s)
- Tushar Nayak
- Department of Orthopaedics, All India Institute of Medical Sciences, New Delhi, India
| | - Samarth Mittal
- Department of Orthopaedics, JPN Apex Trauma Centre, New Delhi, India
| | - Vivek Trikha
- Department of Orthopaedics, JPN Apex Trauma Centre, New Delhi, India
| | - Kamran Farooque
- Department of Orthopaedics, JPN Apex Trauma Centre, New Delhi, India
| | - Shivanand Gamanagatti
- Department of Radiodiagnosis, All India Institute of Medical Sciences, New Delhi, India
| | - Vijay Sharma
- Department of Orthopaedics, JPN Apex Trauma Centre, New Delhi, India,Corresponding author. Department of Orthopaedics, JPN Apex Trauma Centre, New Delhi, India.
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Li J, Tang S, Lam D, Hergrueter A, Dennis J, Liu H. Novel utilization of fascial layer blocks in hip and knee procedures. Best Pract Res Clin Anaesthesiol 2019; 33:539-551. [DOI: 10.1016/j.bpa.2019.07.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2019] [Accepted: 07/09/2019] [Indexed: 12/26/2022]
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Yao S, Chen K, Ji Y, Zhu F, Zeng L, Xiong Z, Sun T, Yang F, Liu J, Guo X. Supra-ilioinguinal versus modified Stoppa approach in the treatment of acetabular fractures: reduction quality and early clinical results of a retrospective study. J Orthop Surg Res 2019; 14:364. [PMID: 31727107 PMCID: PMC6854625 DOI: 10.1186/s13018-019-1428-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2019] [Accepted: 10/22/2019] [Indexed: 11/30/2022] Open
Abstract
Background To compare the efficacy of the operative techniques, complications, reduction quality and hip functional recovery by using the supra-ilioinguinal approach and the modified Stoppa approach for the management of acetabular fractures. Methods A consecutive cohort of 60 patients from September 2014 to October 2017 with displaced acetabular fractures involving the quadrilateral plate were treated operatively with supra-ilioinguinal approach (group A) and modified Stoppa approach (group B), respectively. There were 36 patients in group A and 24 patients in group B. The surgical details, complications, radiographic and clinical results were recorded. The quality of reduction was assessed by measuring the residual step and gap displacement of postoperative CT with a standardized digital method. Results The complications, reduction quality (gaps and steps) and hip function recovery had no significant statistical difference in approaches. The mean operative time was shorter and the mean intraoperative haemorrhage was less in group A. There were statistical differences in the operative time (P = 0.025) and intraoperative haemorrhage (P = 0.003) between the supra-ilioinguinal approach and the modified Stoppa approach. Conclusion Compared to the modified Stoppa approach, the supra-ilioinguinal approach provides a closer visualization to the quadrilateral plate, the operative time was shorter and the intraoperative haemorrhage was clearly less. It is at least equal to or could be a better choice to deal with complicated acetabular fractures especially involving the quadrilateral plate and the anterior one third of the iliac bone.
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Affiliation(s)
- Sheng Yao
- Department of Orthopaedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Kaifang Chen
- Department of Orthopaedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yanhui Ji
- Department of Orthopaedics, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Fengzhao Zhu
- Department of Orthopaedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Lian Zeng
- Department of Orthopaedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Zekang Xiong
- Department of Orthopaedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Tingfang Sun
- Department of Orthopaedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Fan Yang
- Department of Orthopedics, Yongchuan Hospital, Chongqing Medical University, Chongqing, China
| | - Jia Liu
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Xiaodong Guo
- Department of Orthopaedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
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Kachlik D, Vobornik T, Dzupa V, Marvanova Z, Toupal O, Navara E, Stevulova N, Baca V. Where and what arteries are most likely injured with pelvic fractures?: The Influence of Localization, Shape, and Fracture Dislocation on the Arterial Injury During Pelvic Fractures. Clin Anat 2019; 32:682-688. [PMID: 30873674 DOI: 10.1002/ca.23372] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2019] [Revised: 03/04/2019] [Accepted: 03/13/2019] [Indexed: 12/27/2022]
Abstract
Blood vessels passing through pelvic region come into intimate contact with pelvic bone and can be injured by the sharp edges of the dislocated fracture fragments. The aim of the study was to evaluate the influence of localization, shape, and dislocation of individual pelvic ring bones' fractures on arterial injuries. The study group consisted of 474 patients enrolled in a 1-year prospective multicenter study. The pattern of pelvic fracture lines was characterized and recorded on a planar diagram of the subjected side of the pelvis. The diagram was subdivided into 11 designated areas. Frequency of injury at each 11 areas was recorded. The course of individual arteries in the 11 areas was also recorded in relation to each type of pelvic fractures. Out of the 474 investigated patients, the highest proportion of fractures occurred in the areas of the superior (62%) and inferior (59%) ramus of the pubis as well as in the lateral part of the sacrum (19%). These locations can be associated with injuries of the external iliac, obturator, internal iliac, and aberrant obturator arteries. The highest risk of arterial injuries was associated with vertically displaced fractures in the middle part of the superior and inferior pubic rami, along the ischial ramus, in the apex of the greater sciatic notch and in the vicinity of the ventral part of the sacroiliac joint, where the artery runs at a distance of less than 1 cm from the bone. Clin. Anat. 32:682-688, 2019. © 2019 Wiley Periodicals, Inc.
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Affiliation(s)
- David Kachlik
- Department of Anatomy, Second Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Tomas Vobornik
- Department of Orthopedics and Traumatology, Third Faculty of Medicine, Charles University and University Hospital Královské Vinohrady, Prague, Czech Republic
| | - Valer Dzupa
- Department of Orthopedics and Traumatology, Third Faculty of Medicine, Charles University and University Hospital Královské Vinohrady, Prague, Czech Republic.,Center for Integrated Study of Pelvis, Third Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Zuzana Marvanova
- Department of Anatomy, Second Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Ondrej Toupal
- Department of Orthopedics and Traumatology, Third Faculty of Medicine, Charles University and University Hospital Královské Vinohrady, Prague, Czech Republic
| | - Eduard Navara
- Department of Orthopedics and Traumatology, Third Faculty of Medicine, Charles University and University Hospital Královské Vinohrady, Prague, Czech Republic
| | - Nikoleta Stevulova
- Department of Orthopedics and Traumatology, Third Faculty of Medicine, Charles University and University Hospital Královské Vinohrady, Prague, Czech Republic
| | - Vaclav Baca
- Department of Orthopedics and Traumatology, Third Faculty of Medicine, Charles University and University Hospital Královské Vinohrady, Prague, Czech Republic.,Department of Health Care Studies, College of Polytechnics Jihlava, Jihlava, Czech Republic
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Kashyap S, Diwan Y, Mahajan S, Diwan D, Lal M, Chauhan R. The Majority of Corona Mortis Are Small Calibre Venous Blood Vessels: A Cadaveric Study of North Indians. Hip Pelvis 2019; 31:40-47. [PMID: 30899714 PMCID: PMC6414411 DOI: 10.5371/hp.2019.31.1.40] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2018] [Revised: 11/12/2018] [Accepted: 12/06/2018] [Indexed: 12/02/2022] Open
Abstract
Purpose Corona mortis is an abnormal arterial or venous anastomosis between the external iliac and the obturator system of vessels and may cause significant hemorrhage during pelvi-acetabular fracture surgeries, hernia repair and laparoscopic gynecological procedures. Previous studies have estimated a prevalence of corona mortis between 34% and 70%. This cadaveric study was conducted to estimate the prevalence of corona mortis in the North Indian population. Materials and Methods Twelve cadavers (24 hemipelvises; 11 males and 1 female) with a mean age of 68 (range, 54–82) years were included in this study. Results Corona mortis was observed in 14 hemipelvises (58.3%). A total of 19 (79.2%) vascular anastomoses of diameter greater than 1 mm were observed; 5 hemipelvises (20.8%) had corona mortis on the right side, 9 hemipelvises (37.5%) on the left side and bilateral in 5 (41.7%) cases. Two hemipelvises (8.3%) had an arterial connection. An aberrant obturator artery was observed in 1 (4.2%) hemipelvis. A venous connection was found in 14 specimens (58.3% of hemipelvises). The average distance of the connecting vein from the symphysis pubis was 41 (35–70) mm. A vessel diameter of greater than 4 mm was observed in 4/24 (16.7%) of hemipelvises. Conclusion The frequency of venous corona mortis was higher than arterial corona mortis and the majority (83.3%) were small calibre (<4 mm). The presentation pattern and the number of arterial or venous anastomoses were different in the majority of hemipelvises and dissimilar in both hemipelvises of the same cadaver in the majority of cases.
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Affiliation(s)
- Sandeep Kashyap
- Department of Orthopaedics, Indira Gandhi Medical College, Shimla, India
| | - Yogesh Diwan
- Department of Anatomy, Indira Gandhi Medical College, Shimla, India
| | - Shweta Mahajan
- Department of Anaesthesia and Intensive Care, Indira Gandhi Medical College, Shimla, India
| | - Deepa Diwan
- Department of Anatomy, Indira Gandhi Medical College, Shimla, India
| | - Mukand Lal
- Department of Orthopaedics, Indira Gandhi Medical College, Shimla, India
| | - Randhir Chauhan
- Department of Anatomy, Indira Gandhi Medical College, Shimla, India
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Corona mortis variant of the obturator artery: a systematic study of 300 hemipelvises by means of computed tomography angiography. Pol J Radiol 2018; 83:e519-e523. [PMID: 30800190 PMCID: PMC6384405 DOI: 10.5114/pjr.2018.81441] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2018] [Accepted: 12/17/2018] [Indexed: 11/17/2022] Open
Abstract
Purpose The purpose of the present study is to systematically assess the prevalence and characteristics of the corona mortis (CM) variant of the obturator artery by means of computerised tomography angiography (CTA). Material and methods A total of 150 consecutive patients (112 males, average age 73 years) referred to CTA for lower limb arterial evaluation were included in this retrospective study. Patient demographics, anastomosis incidence, artery diameter, distance from the symphysis pubis, Kellgren-Lawrence score, and pelvic size were evaluated. Results In this study 40.6% of patients presented at least one competent CM arterial anastomosis. In the 300 evaluated arteries, 90 arterial anastomoses were found (30%), 40 on the right side (average diameter 1.63 mm) and 50 on the left side (1.78 mm). In 32 cases there was only one anastomosis, while in 29 cases the CM was bilateral. No anastomoses were detected in 89 patients. Mean distance from the symphysis was 50 mm. No relevant association with hip osteoarthrosis was found for CM. Mean pelvic size was 213 mm. Conclusions The evidence from this study suggests that CM is a common variant that needs to be acknowledged before pelvic intervention.
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Leite TFDEO, Pires LAS, Goke K, Silva JG, Chagas CAA. Corona Mortis: anatomical and surgical description on 60 cadaveric hemipelvises. ACTA ACUST UNITED AC 2018; 44:553-559. [PMID: 29267551 DOI: 10.1590/0100-69912017006001] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2017] [Accepted: 07/20/2017] [Indexed: 02/06/2023]
Abstract
OBJECTIVE to report the prevalence of arterial corona mortis and to describe its surgical and clinical applicabilities. METHODS We dissected 60 hemipelvises (50 men and 10 women) fixed in a 10% formalin solution for the purpose of gathering information on corona mortis. We measured the caliber and length of the obturator artery and its anastomotic branch with the aid of a digital caliper and submitted the data to statistical analyzes and comparisons with the GraphPad Prism 6 software. RESULTS arterial corona mortis was present in 45% of the studied sample. The most common origin of the obturator artery was the internal iliac artery; however, there was one exceptional case in which it originated from the femoral artery. The caliber of the anastomotic branch was on average 2.7mm, whereas the caliber of the obturator artery was 2.6mm. CONCLUSION the vascular connections between the obturator, internal iliac, external iliac and inferior epigastric arterial systems are relatively common over the upper pubic branch. The diameter and a trajectory of the anastomotic artery may vary. Thus, iatrogenic lesions and pelvic and acetabular fractures can result in severe bleeding that puts the patient's life at risk.
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Affiliation(s)
| | | | - Kiyoshi Goke
- - Estácio de Sá University, Department of Anatomy, Rio de Janeiro, RJ, Brazil
| | - Júlio Guilherme Silva
- - Federal University of Rio de Janeiro, Department of Physiotherapy, Rio de Janeiro, RJ, Brazil
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Abstract
The success of an inguinal hernia repair is defined by the permanence of the operation while creating the fewest complications at minimal cost and allowing patients an early return to activity. This success relies and depends on the surgeon's knowledge and understanding of groin anatomy and physiology. This article reviews relevant anatomy to inguinal hernia repair and technical steps to open tissue and mesh repairs as well as minimally invasive approaches.
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Affiliation(s)
- Heidi J Miller
- Department of Surgery, MSC 10 5610, University of New Mexico, Albuquerque, NM 87131, USA.
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Sanna B, Henry BM, Vikse J, Skinningsrud B, Pękala JR, Walocha JA, Cirocchi R, Tomaszewski KA. The prevalence and morphology of the corona mortis (Crown of death): A meta-analysis with implications in abdominal wall and pelvic surgery. Injury 2018; 49:302-308. [PMID: 29241998 DOI: 10.1016/j.injury.2017.12.007] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2017] [Revised: 11/14/2017] [Accepted: 12/07/2017] [Indexed: 02/02/2023]
Abstract
PURPOSE Corona mortis is a highly variable vascular connection between the obturator and external iliac or inferior epigastric arteries or veins located behind the superior pubic ramus in the retropubic space (space of Retzius). Due to the significant variation in this collateral circulation, detailed anatomical knowledge of the corona mortis is vital to enhance the prevention of possible iatrogenic errors in hernia repair and other pubic surgical procedures. The aim of our meta-analysis was to provide comprehensive data on the prevalence, anatomical characteristics, and ethnic variations of the corona mortis vessel. METHODS An extensive search was conducted through the major electronic databases to identify eligible articles. Data extracted included investigative method, prevalence of the corona mortis vessels among hemi-pelvises (overall, arterial only, venous only, and combined), distance from the corona mortis to pubic symphysis, and assessment of gender, side, laterality, and ethnicity subgroups. RESULTS A total of 21 studies (n=2184 hemi-pelvises) were included in the meta-analysis. The overall prevalence of the corona mortis in hemi-pelvises is high (49.3%). A venous corona mortis is more prevalent than an arterial corona mortis (41.7% vs. 17.0%). The corona mortis is more common in Asia (59.3%) than in Europe (42.8%) and North America (44.3%). CONCLUSIONS As a corona mortis is present in an about half of all hemi-pelvises, it is important to consider the possibilities of its presence when undertaking surgical procedures and plan accordingly to avoid injuries. All surgeons operating in the retropubic region should have a thorough understanding of the anatomical characteristics and surgical implications of a corona mortis.
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Affiliation(s)
- Beatrice Sanna
- International Evidence-Based Anatomy Working Group, Krakow, Poland; Faculty of Medicine & Surgery, University of Cagliari, Sardinia, Italy
| | - Brandon Michael Henry
- International Evidence-Based Anatomy Working Group, Krakow, Poland; Department of Anatomy, Jagiellonian University Medical College, Krakow, Poland.
| | - Jens Vikse
- International Evidence-Based Anatomy Working Group, Krakow, Poland; Division of Medicine, Stavanger University Hospital, Stavanger, Norway
| | - Bendik Skinningsrud
- International Evidence-Based Anatomy Working Group, Krakow, Poland; Department of Anatomy, Jagiellonian University Medical College, Krakow, Poland
| | - Jakub R Pękala
- International Evidence-Based Anatomy Working Group, Krakow, Poland; Department of Anatomy, Jagiellonian University Medical College, Krakow, Poland
| | - Jerzy A Walocha
- International Evidence-Based Anatomy Working Group, Krakow, Poland; Department of Anatomy, Jagiellonian University Medical College, Krakow, Poland
| | | | - Krzysztof A Tomaszewski
- International Evidence-Based Anatomy Working Group, Krakow, Poland; Department of Anatomy, Jagiellonian University Medical College, Krakow, Poland
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Life-threatening hemorrhage from the corona mortis treated with balloon-assisted coiling technique. Am J Emerg Med 2017; 36:527.e1-527.e3. [PMID: 29237541 DOI: 10.1016/j.ajem.2017.12.021] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2017] [Revised: 12/07/2017] [Accepted: 12/07/2017] [Indexed: 11/20/2022] Open
Abstract
Isolated pubic ramus fractures are common and generally uncomplicated injuries in the elderly. However, pubic ramus fractures are closely related to important vascular structures. The corona mortis, located in the retropubis, has an important anastomotic value, as it serves as a communication between the internal and external iliac vessels. The following case report describes an 88-year-old male who was diagnosed with a right superior pubic ramus fracture, which led to a severe picture of hemodynamic instability. Emergent angiography demonstrated injury of the corona mortis. After super-selective embolization of the corona mortis artery with a balloon-assisted coiling technique, the patient progressed satisfactorily and was discharged after 7days.
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Rich C, Rayner J, Raukar N. Nondisplaced pubic ramus fracture associated with exsanguination and death. Am J Emerg Med 2017; 36:342.e1-342.e2. [PMID: 29150225 DOI: 10.1016/j.ajem.2017.10.062] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2017] [Accepted: 10/25/2017] [Indexed: 01/06/2023] Open
Abstract
We present a case of an elderly man who sustained non-displaced fractures through the right superior and inferior pubic rami after a fall from standing and had a tragic outcome. While minimally displaced pubic ramus fractures are typically stable and require only symptomatic treatment, there have been reports, such as this one, of low-energy pubic rami fractures resulting in massive hemorrhage. Despite aggressive resuscitation and embolization of the right obturator artery, our patient ultimately died during his hospitalization. This report highlights the need to maintain a high index of suspicion for intrapelvic bleeds even in patients with nondisplaced pubic rami fractures. Rapid recognition and treatment of intrapelvic bleeds can be lifesaving.
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Affiliation(s)
- Chana Rich
- Department of Emergency Medicine, Alpert Medical School of Brown University, United States.
| | - James Rayner
- Department of Emergency Medicine, Alpert Medical School of Brown University, United States.
| | - Neha Raukar
- Department of Emergency Medicine, Alpert Medical School of Brown University, United States.
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Corona mortis anastomosis: a three-dimensional computerized tomographic angiographic study. Emerg Radiol 2017; 24:519-523. [PMID: 28397010 DOI: 10.1007/s10140-017-1502-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2017] [Accepted: 03/31/2017] [Indexed: 10/19/2022]
Abstract
PURPOSE We evaluated the corona mortis (CM) anatomy by means of three-dimensional computerized tomography angiographic (CTA). METHODS Patient demographic, anastomosis incidence, artery diameter, artery distance from the symphysis pubis, and pelvic size (distance between both acetabular upper labrum) parameters were assessed. The 100 patients included 66 males and 34 females (average age of 67.8 years). RESULTS There were 66 (33%) arterial anastomoses in the 200 evaluated arteries, 30 in the right side and 36 in the left side, 36 unilaterally and 15 bilaterally. No anastomoses were detected in 49 patients. The average diameter was 2.4 mm for the right-sided arteries and 2.24 in the left-sided ones. The distance was 55.2 mm from the right symphysis and 57.2 from the left symphysis (greater for females, 62.2 versus 55.85 mm [p = 0.037] only on the left side). The artery disappears in smaller-sized pelvises. There was a non-occluded arterial pattern in 47 (71%) and a partially occluded one in 19 (29%, all with peripheral vascular disease). CONCLUSION One-third of the evaluated CTAs revealed competent CMs. CMs were more lateral in females than in males and were absent in small-sized pelvises. It is highly recommended that the radiologist and the surgeon should be familiar with CM existence for decision-making with regard to emergency radiology imaging and intervention as well as when operating in proximity of that anatomic site.
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