Anatomical features of venous and arterial corona mortis in fresh cadavers in the Turkish population and anatomical landmarks to be used during surgical procedures

Year 2023, Volume: 17 Issue: 3, 103 - 109, 29.12.2023

Zekiye Gözde Kara , Aysun Uz

Abstract

Objectives: The aim of this study is to determine the topographic position of the corona mortis on fresh cadavers and also to determine anatomical landmarks that will facilitate surgeons to consider to this structure during operations by clarifying the relationship of the corona mortis with the surrounding anatomical structures.
Methods: A total of 50 autopsy cases of 31 men and 19 women, all examined within 24 hours post-mortem, were evaluated bilaterally for the presence of corona mortis. When identified, the vascular characteristics (arterial/venous) of the corona mortis were documented. The topographic position of the corona mortis was determined by measuring the distances to the pubic symphysis, promontory, obturator nerve and anterior superior iliac spine. The study also investigated whether some anthropometric measurements affect these distances.
Results: Out of the 100 hemipelves examined, corona mortis were observed in 50 cases. Among these, 34% were arterial (n=17), and 66% were venous (n=33). Anastomoses were identified in the hemipelves of 22 women and 28 men, with no significant gender difference (p>0.05). The average distances to anatomical landmarks were as follows: 5.43 cm to the pubic symphysis, 1.77 cm to the obturator nerve, 9.87 cm to the promontory, and 10.56 cm to the anterior superior iliac spine.
Conclusion: Corona mortis poses a significant risk in surgical procedures. Knowing the vascular anatomy of the pelvis is vital for gynecological, urological and orthopedic interventions, while investigating deaths caused by pelvic trauma is important for forensic practice. This anatomical study contributes to a better understanding of the complex and intricate pelvic structure.

Keywords

autopsy study, corona mortis, pelvis, variant obturator artery

References

• 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;8:354–9.
• Borley N. Peritoneum and peritoneal cavity. In: Standring S, editor. Gray’s anatomy: the anatomical basis of clinical practice. 40th ed. London: Churchill Livingstone; 2008. pp. 1099–110.
• Arıncı K, Elhan A. Anatomi. 7th ed. Ankara: Güneş Kitabevi; 2020. Vol. 2. p. 62–8.
• Pieroh P, Li ZL, Kawata S, Ogawa Y, Josten C, Steinke H, Itoh M. The arterial blood supply of the symphysis pubis–spatial orientated and highly variable. Ann Anat 2021;234:151649.
• Marvanova Z, Kachlik D. The anatomical variability of obturator vessels: systematic review of literature. Ann Anat 2024;251:152167.
• Gobrecht U, Kuhn A, Fellman B. Injury of the corona mortis during vaginal tape insertion (TVT-Secur™ using the U-Approach). Int Urogynecol J 2011;22:443–5.
• Castellani D, Saldutto P, Galica V, Masciovecchio S, Galatioto GP, Vicentini C. Transobturator surgery in presence of corona mortis: a study in 13 women. Urologia 2016;83:200–3.
• Tornetta P 3rd, Hochwald N, Levine R. Corona mortis. Incidence and location. Clin Orthop Relat Res 1996;(329):97–101.
• Kostov S, Slavchev S, Dzhenkov D, Stoyanov G, Dimitrov N, Yordanov AD. Corona mortis, aberrant obturator vessels, accessory obturator vessels: clinical applications in gynaecology. Folia Morphol (Warsz) 2021;80:776–85.
• Yang XF, Liu JL. Anatomy essentials for laparoscopic inguinal hernia repair. Ann Transl Med 2016;4:372.
• Gültaç E, Kilinc CY, Can Fİ, Şahin İG. Açan AE, Gemci Ç, Aydoğan NH. A device that facilitates screwing at an appropriate angle in quadrilateral surface fractures: 105-degree drill attachment. Turk J Med Sci 2022;52:816–24.
• Perandini S, Perandini A, Puntel G, Puppini G, Montemezzi S. Corona mortis variant of the obturator artery: a systematic study of 300 hemipelvises by means of computed tomography angiography. Pol J Radiol 2018;83:e519–23.
• Talalwah WA. A new concept and classification of corona mortis and its clinical significance. Chin J Traumatol 2016;19:251–4.
• Kachlik D, Musil V, Blankova A, Marvanova Z, Miletin J, Trachtova D, Dvorakova V, Baca V. A plea for extension of the anatomical nomenclature: vessels. Bosn J Basic Med Sci 2021;21:208.
• Berberoğlu M, Uz A, Özmen MM, Bozkurt C, Erkuran C, Taner S, Tekin A, Tekdemir I. Corona mortis: an anatomic study in seven cadavers and an endoscopic study in 28 patients. Surg Endosc 2001;15:72–5.
• Wada T, Itoigawa Y, Wakejima T, Koga A, Ichimura K, Maruyama Y, Ishijima M. Anatomical position of the corona mortis relative to the anteroposterior and inlet views. Eur J Orthop Surg Traumatol 2022;32:1–5.
• Küper MA, Ateschrang A, Hirt B, Stöckle U, Stuby FM, Trulson A. Laparoscopic acetabular surgery (LASY)–vision or illusion? Orthop Traumatol Surg Res 2021;107:102964.
• Cardoso GI, Chinelatto LA, Hojaij F, Akamatsu FE, Jacomo AL. Corona mortis: a systematic review of literature. Clinics (Sao Paulo) 2021;76:e2182.
• Okcu G, Erkan S, Yercan H, Ozic U. The incidence and location of corona mortis: a study on 75 cadavers. Acta Orthop Scand 2004;75:53–5.
• 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;12:108–14.
• Ates M, Kinaci E, Kose E, Soyer V, Sarici B, Cuglan S, Dirican A. Corona mortis: in vivo anatomical knowledge and the risk of injury in totally extraperitoneal inguinal hernia repair. Hernia 2016;20:659–65.
• Subedi N, Yadav BN, Jha S, Paudel IS, Regmi R. A profile of abdominal and pelvic injuries in medico-legal autopsy. J Forensic Leg Med 2013;20:792–6.
• Höch A, Özkurtul O, Hammer N, Heinemann A, Tse R, Zwirner J, Ondruschka B. A comparison on the detection accuracy of ante mortem computed tomography vs. autopsy for the diagnosis of pelvic ring injury in legal medicine. J Forensic Sci 2021;66:919–25.
• Sanna B, Henry BM, Vikse J, Skinningsrud B, Pękala JR, Walocha JA, 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;49:302–8.
• Beya R, Jérôme D, Tanguy V, My-Van N, Arthur R, Richer J, Faure J. Morphologic study of the corona mortis using the Simlife® technology. Surg Radiol Anat 2023;45:89–99.
• Karakurt L, Karaca I, Yilmaz E, Burma O, Serin E. Corona mortis: incidence and location. Arch Orthop Trauma Surg 2002;122:163–4.
• Gülhan Ö. Sex estimation from the pelvis using radiological methods: Turkish sample. Antropoloji 2018;36:53–69.
• Puntambekar S, Nanda SM, Parikh K. Laparoscopic pelvic anatomy in females: applied surgical principles. Singapore: Springer; 2019. p. 215–8.
• Marzi I, Lustenberger T. Management of bleeding pelvic fractures. Scand J Surg 2014;103:104–11.
• Fernandes RMP, de Oliveira Leite TF, Pires LAS. A review of the corona mortis with clinical and surgical applications to orthopedics. Acta Scientiae Anatomica 2019;1:122–7.