scholarly journals EP.FRI.680 “Avulsion of the Corona Mortis following low energy pubic rami fracture: a rare but life-threatening injury.”

2021 ◽  
Vol 108 (Supplement_7) ◽  
Author(s):  
Anurag Sinha ◽  
Mark Kemp ◽  
Satish Rohra
Keyword(s):  
Low Energy ◽  
Haemodynamic Instability ◽  
Obturator Artery ◽  
Pubic Rami ◽  
Corona Mortis ◽  
Epigastric Artery ◽  
Arterial Bleeding ◽  
Ct Angiogram ◽  
Internal Iliac ◽  
Life Threatening

Abstract We describe the case of an 81 year old gentleman who presented after a trivial fall with haemodynamic instability and worsening abdominal pain and swelling. An initial trauma CT identified superior and inferior pubic rami fractures associated with a large intra-pelvic collection. A subsequent CT angiogram confirmed a large pelvic haematoma with an active arterial bleeding from a ruptured vessel adjacent to the superior pubic rami fracture. This was managed by resuscitating him with fluids and blood transfusions followed by fluoroscopic guided Internal Iliac artery embolisation. The “Corona Mortis” is an aberrant arterial connection between the inferior epigastric artery and obturator artery and is prevalent in the hemipelvis of more than 49.3% of the population. Very rarely it can be damaged during low energy pubic rami fractures leading to haemodynamic compromise and potential death. For this reason and the fact there is a high chance that it could be missed, we wish to highlight this case, and management and emphasise the need to consider this life-threatening complication even in cases when the mechanism of injury may seem trivial.

scholarly journals Anatomical variation of obturator vessels and its practical risk: a case report from an anatomic study

2008 ◽  
Vol 7 (3) ◽  
pp. 275-277 ◽  
Author(s):  
Somayaji Nagabhooshana ◽  
Venkata Ramana Vollala ◽  
Vincent Rodrigues ◽  
Seetharama Bhat ◽  
Narendra Pamidi ◽  
...  
Keyword(s):  
Iliac Artery ◽  
Anatomical Variation ◽  
External Iliac Artery ◽  
Iliac Vein ◽  
Inferior Epigastric Artery ◽  
Undergraduate Medical Students ◽  
Obturator Artery ◽  
External Iliac Vein ◽  
Epigastric Artery ◽  
Internal Iliac

Obturator artery is frequently a branch of anterior division of the internal iliac artery. It has drawn attention of pelvic surgeons, anatomists and radiologists because of the high frequency of variations in its course and origin. The obturator vein is usually described as a tributary of the internal iliac vein. During routine dissection classes to undergraduate medical students we have observed obturator artery arising from external iliac artery, obturator vein draining into external iliac vein, communicating vein between obturator vein and external iliac vein and inferior epigastric artery arising from the obturator artery. The anomalous obturator vessels and inferior epigastric artery in the present case may be in a dangerous situation in pelvic surgeries that require dissection or suturing along the pelvic rim. Developmental reasons and clinical significances of the variations are discussed.

scholarly journals Corona Mortis : anatomical and surgical description on 60 cadaveric hemipelvises

2017 ◽  
Vol 44 (6) ◽  
pp. 553-559 ◽  
Author(s):  
TÚLIO FABIANO DE OLIVEIRA LEITE ◽  
LUCAS ALVES SARMENTO PIRES ◽  
KIYOSHI GOKE ◽  
JÚLIO GUILHERME SILVA ◽  
CARLOS ALBERTO ARAUJO CHAGAS
Keyword(s):  
Femoral Artery ◽  
Internal Iliac Artery ◽  
Exceptional Case ◽  
Acetabular Fractures ◽  
Severe Bleeding ◽  
Obturator Artery ◽  
Corona Mortis ◽  
Internal Iliac ◽  
Vascular Connections ◽  
Digital Caliper

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.

Hemorrhage Secondary to Pelvic Fracture: Coil Embolization of an Aberrant Obturator Artery

2003 ◽  
Vol 10 (3) ◽  
pp. 676-680 ◽  
Author(s):  
Bernd Daeubler ◽  
Suzanne E. Anderson ◽  
Michael Leunig ◽  
Jürgen Triller
Keyword(s):  
Iliac Artery ◽  
Coil Embolization ◽  
Internal Iliac Artery ◽  
Pelvic Ring ◽  
External Iliac Artery ◽  
Vascular Anomaly ◽  
Abdominal Ultrasound ◽  
Obturator Artery ◽  
Corona Mortis ◽  
Internal Iliac

Purpose: To describe the anatomical variations of the corona mortis, a vascular anomaly that may lead to dangerous hemorrhage and possible death. Case Report: A 46-year-old male cyclist was involved in a collision with a car, during which he sustained fractures to the left ribs and pelvic ring. Abdominal ultrasound imaging demonstrated a large (12×6×7 cm) nonhomogeneous mass ventral to the bladder, suggestive of a hematoma, which was confirmed on computed tomography. During angiography, 2 branches of the internal iliac artery were identified as sources of the bleeding; these were successfully embolized with microcoils, but the bleeding continued. Examination of the external iliac system found a lacerated aberrant obturator artery arising from the inferior epigastric branch of the external iliac artery, a condition known as the corona mortis. Additional embolization quelled the hemorrhage. Conclusions: Coil embolization of the internal iliac artery branches is very effective in managing hemorrhage due to pelvic fractures, but variations in the origin of the obturator artery from the internal or external iliac artery may be additional sources of bleeding.

scholarly journals A Case Report on Life-Threatening Lower Gastrointestinal Bleeding: A Rare Presentation of Mucinous Adenocarcinoma of the Appendix

2021 ◽  
Vol 2021 ◽  
pp. 1-6
Author(s):  
H. W. T. D. Wijayaratne ◽  
K. J. A. Fernando ◽  
T. Matheeshan
Keyword(s):  
Gastrointestinal Bleeding ◽  
Rectal Bleeding ◽  
Mucinous Adenocarcinoma ◽  
Right Hemicolectomy ◽  
Lower Gastrointestinal Bleeding ◽  
Haemodynamic Instability ◽  
Endoscopic Evaluation ◽  
Ct Angiogram ◽  
Contrast Enhanced Ct ◽  
Life Threatening

Introduction. A life-threatening lower gastrointestinal bleeding from mucinous adenocarcinoma of the appendix is a rare occurrence. Diagnosing and management of such a condition are challenging. Case Presentation. A 73-year-old male with a history of type 2 diabetes mellitus and hypertension presented with intermittent per rectal bleeding for two weeks, which progressed to the passage of a large number of blood clots and fresh blood. He had features of class III shock on admission. An endoscopic evaluation followed initial resuscitation to locate the source of bleeding. Colonoscopy revealed a large blood clot at the opening of the appendicular orifice with no active bleeding. Oesophagoduodenoscopy, contrast-enhanced CT abdomen, and CT angiogram findings were unremarkable. Due to repeated episodes of rebleeding leading to haemodynamic instability, an exploratory laparotomy was performed. A retrocaecal appendix was noticed with a macroscopically suspicious-looking dilated tip adhered to the posterior caecal wall. Right hemicolectomy was performed as the lesion was suspicious and to stop bleeding from the site. Ileocolic side-to-side hand-sewn anastomosis was performed using 3/0 polyglactin. Postoperatively, per rectal bleeding was settled. Microscopy revealed appendiceal mucinous adenocarcinoma with AJCC staging of pT3NoMx. The patient was discharged on postoperative day seven and referred to oncological management. He was offered six cycles of chemotherapy with capecitabine and oxaliplatin. At the six-month follow-up visit, the patient had no features of recurrence clinically. Conclusion. Mucinous adenocarcinoma of the appendix can rarely present as life-threatening lower GI bleeding. Prompt resuscitation, endoscopic evaluation, and operative management with right hemicolectomy and chemotherapy provided a good outcome.

scholarly journals Unusual presentation of a life-threatening intraperitoneal haemorrhage after elective inguinal hernia repair

2018 ◽  
Vol 11 (1) ◽  
pp. bcr-2018-226676
Author(s):  
Kenrick Kai Chi Chan ◽  
Shahab Khan ◽  
Christopher Lewis
Keyword(s):  
Inguinal Hernia ◽  
Hernia Repair ◽  
Inguinal Hernia Repair ◽  
Tertiary Centre ◽  
Epigastric Artery ◽  
Ct Angiogram ◽  
Life Threatening ◽  
Open Inguinal Hernia Repair ◽  
Induction Of Anaesthesia ◽  
Intraperitoneal Haemorrhage

A 57-year-old man who was hypotensive at induction of anaesthesia was having intermittent episodes of hypotension after an uncomplicated and relatively bloodless open inguinal hernia repair of a large left-sided hernia . His hypotension was responsive to small fluid boluses. He did not show any tachycardia, had no abdominal pain, no signs of bruising or bleeding in his abdomen, flanks, or scrotum. Remained clinically well and alert throughout until being transferred to a tertiary centre. Eventually became haemodynamically unstable approximately 6 hours postoperatively. CT angiogram showed a large haemoperitoneum with active bleeding. Diagnostic laparoscopy revealed an actively bleeding inferior epigastric artery which was stopped. The patient received 2 units of red blood cells and made a full recovery.

scholarly journals Importance of Both Internal and External Iliac Artery Interrogation in Pelvic Trauma as Evidenced by Hemorrhage from Bilateral Corona Mortis with Unilateral Aberrant Origin off the External Iliac Artery

2019 ◽  
Vol 2019 ◽  
pp. 1-4
Author(s):  
Michael Herskowitz ◽  
James Walsh ◽  
Meghan Lilly ◽  
Kimberly McFarland
Keyword(s):  
Iliac Artery ◽  
External Iliac Artery ◽  
Hemodynamic Instability ◽  
Pelvic Trauma ◽  
Obturator Artery ◽  
Iliac Arteries ◽  
Corona Mortis ◽  
Internal Iliac ◽  
Blunt Pelvic Trauma ◽  
Internal Iliac Arteries

Transcatheter angiography and embolization has long been recognized as the gold standard for patients with hemodynamic instability secondary to blunt pelvic trauma. While often the bleeding source can be readily localized based on the distribution of extravasation on preprocedural Computed Tomographic Angiography, one should be cautious in assessment for aberrant anatomy. A variant obturator artery originating from the inferior epigastric branch of the external iliac artery is commonly referred to as the corona mortis. We present a case of blunt pelvic trauma in which a patient demonstrated extravasation in the anterior distributions of both internal iliac arteries. Following embolization of bilateral internal iliac arteries, identification and embolization of bilateral corona mortis branches was crucial to achieving hemodynamic stability in this patient.

scholarly journals The inferior epigastric artery arising from the internal iliac artery via a common trunk with the obturator artery

2012 ◽  
Vol 45 (4) ◽  
pp. 285 ◽  
Author(s):  
Hyung-Sun Won ◽  
Hyung-Jin Won ◽  
Chang-Seok Oh ◽  
Seung-Ho Han ◽  
In-Hyuk Chung ◽  
...  
Keyword(s):  
Iliac Artery ◽  
Internal Iliac Artery ◽  
Common Trunk ◽  
Inferior Epigastric Artery ◽  
Obturator Artery ◽  
Epigastric Artery ◽  
Internal Iliac

scholarly journals Stable fracture of the pubic rami: a rare cause of life-threatening bleeding from the inferior epigastric artery managed with transcatheter embolization

CJEM ◽  
2008 ◽  
Vol 10 (04) ◽  
pp. 392-395 ◽  
Author(s):  
Romaric Loffroy ◽  
Jean-Michel Yeguiayan ◽  
Boris Guiu ◽  
Jean-Pierre Cercueil ◽  
Denis Krausé
Keyword(s):  
Transcatheter Arterial Embolization ◽  
Pelvic Ring ◽  
Rare Complication ◽  
Arterial Embolization ◽  
Ct Scanning ◽  
Transcatheter Embolization ◽  
Inferior Epigastric Artery ◽  
Pubic Rami ◽  
Epigastric Artery ◽  
Life Threatening

ABSTRACT Extraperitoneal bleeding from the inferior epigastric artery (IEA) and its branches is a rare complication of blunt pelvic trauma; however, it can result in life-threatening hemorrhage, even in cases of minimally displaced fractures of the pelvic ring. We report the case of a patient who had post-traumatic pelvic hematoma and cardiovascular collapse caused by avulsion of the right pubic branch of the IEA related to undisplaced fractures of the pubic rami. CT scanning followed by angiography showed leakage of contrast from the IEA. Transcatheter arterial embolization was performed to successfully control the hemorrhage. There have been very few previous reports of IEA injury related to stable fractures of the pubic rami successfully treated by transcatheter arterial embolization.

scholarly journals A Study of Variations in the Origin of Obturator Artery in the Human Cadavers and its Clinical Significance

2017 ◽  
Vol 06 (01) ◽  
pp. 042-050
Author(s):  
Sanjeev Kumar ◽  
Smita Minz
Keyword(s):  
Clinical Significance ◽  
Clinical Symptoms ◽  
Common Variant ◽  
Superior Gluteal Artery ◽  
Obturator Artery ◽  
Epigastric Artery ◽  
Internal Iliac ◽  
Human Cadavers ◽  
Anterior Division ◽  
Variable Origin

Abstract Background and aims: Study of origin of obturator artery, its variable origin and course is significant as knowledge attained by such studies help surgeons to avoid injuries, hemorrhage during operative procedures. Present study is aimed at finding out the variable origin of obturator artery, clinical significance and to correlate its embryological basis. Materials and Methods: Present study was conducted on 60 formalin fixed hemi section of cadaveric pelvis, which were allotted to the under graduate students of Mandya Institute of Medical Sciences, Mandya. Observations obtained were compared with the studies of previous workers. Results: Normal pattern of origin, from the anterior division of internal iliac artery was seen in 40% (24 cadavers). In 60% of the cadavers variations were observed. The most common variant mode of origin was from inferior epigastric artery (18.3%). Next common was origin from superior gluteal artery and least common variant of origin was from inferior vesical artery. Conclusion: Variations observed in present study were at par with the variations observed by previous studies. Although anomalous origins of the obturator artery rarely produces clinical symptoms, their knowledge is necessary for operating surgeons to avoid injuries and is of academic interest.

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