A study of the incidence of the corona mortis within a South African patient sample using computerized tomographic angiography

Abstract

Introduction: Retropubic hematomas are a common development in cases of pelvic ring trauma and post- operative repair of fractures to the anterior column of the pelvis. Early detection and diagnosis of such events using computed tomography angiography (CTA) are critical for successful intervention and patient recovery, especially when bleeding is a result of injury to the corona mortis (CM). The CM is the communication between the obturator vessels and the external iliac vessels typically via an accessory obturator vessel. This communication of vessels is identified as a major hindrance in anterior approaches to the pelvis.

Materials and methods: This study investigated the incidence of CM and mapped out safe zones for the anastomosis in a South African sample using 73 adult angiograms from the Department of Diagnostic Radiology, Universitas Academic Hospital. After careful observation of the iliac system, the incidence of CM was documented. The distance from the CM to clinically relevant bony landmarks were recorded to formulate safe zones.

Results: The incidence of CM was observed in 33.1 % of the sample, with 20 % being venous and 13.1 % being arterial anastomoses. Statistically significant differences between the sexes were noted for safe zones between all landmarks except for the pubic tubercle (p ≥ 0.26). The safe zone between the CM and the pubic tubercle were documented as 46.88 mm and the average diameter for all anastomotic vessels was noted as 2.83 mm (Range: 1.75 - 4.61 mm).

Conclusion: The inconsistencies presented in angiogram studies compared to cadaver studies suggest that angiograms should be limited to a diagnostic and therapeutic role of identifying the CM or injury thereof in the retropubic region. However, measurements concerning safe zones should rather be extracted from cadaveric studies.

Keywords: Anastomosis; Angiogram; Computed tomography angiography; Modified stoppa approach; Safe zone.