A Large-diameter Corona Mortis Artery Encountered During Surgery for Acetabular Fracture: A Case Report and Review of...

The corona mortis (CM) artery or ("crown of death") is a vascular anastomosis between the obturator artery and either the external iliac or inferior epigastric artery. An anastomosis is defined as one or more vessels that merge with other vessels before dividing. The CM's clinical significance arises from its potential of bleeding you can have if injured while performing any pelvic or acetabular surgeries. It is estimated that 25-33% of people have a CM artery and anatomical diameter and location variability is common. Surgeons should have a high index of suspicion and awareness.

We report the case of a 25-year-old woman who was involved in a motor vehicle accident where she sustained a displaced acetabular fracture involving the anterior column and superior pubic ramus. During the surgical approach for acetabular fracture fixation, we identified an artery that had characteristics of a CM artery. The artery in question measured approximately 16 mm in circumference, which would equal approximately 5 mm in diameter; this is large in comparison to the average diameter of 2-4 mm. Because of the increased possibility of bleeding, we were able to safely dissect, tag, and retract the artery. The surgery proceeded uneventfully and the patient had an uneventful consistent postoperative recovery.

This case highlights the need to recognize and deal with vascular structures, like a large-diameter CM artery in this case, during pelvic surgeries. The intra-operative identification and tagging were critical to avoiding hemorrhagic complications. Pre-operative vascular imaging and intra-operative awareness are an important way of avoiding surgical risk in the case of any anterior pelvis surgery.