Corona Mortis: A Systematic Review of Literature

Abstract

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

Figure 1. Inclusion Flowchart. BVS-Portal Regional da Biblioteca Virtual em Saúde, including LILACS (Literatura Latino-Americana e do Caribe em Saúde), MEDLINE (Medical Literature Analysis and Retrieval System Online) and IBECS (indice bibliografico espaãol en ciencias de la salud). SciELO- Scientific Eletronic Library Online.

Figure 2. Types of Studies. n=number of studies considered in this graphic; dissection=cadaveric dissection; Intraoperative+dissection=studies that include surgeries reports and cadaveric dissections. Vascular radiographic studies are mainly pelvic or lower extremity angiographies. Intraoperative studies are performed in hernia or acetabulum fracture repair surgeries, for example.

Figure 3. Incidence of Corona Mortis. CM: Corona Mortis. n: total number of articles considered in each graphic.

Figure 4. Mean Incidences of Corona Mortis. n=total number of hemipelvises considered in this graphic. The standard deviations are indicated as bars in the figure, and the percentages are calculated considering hemipelvises. In studies performed with cadavers and surgical patients, data was compiled to a single analysis, except in one of the studies (33), in which only the cadaveric research is used because, in surgeries, it does not accurately discriminate arteries from veins.

Figure 5. Presence of Corona Mortis. CM=Corona Mortis; n=total number of pelvises analyzed (7,11,12,18,20,21,27,31,33,39).