Our Sponsors caatmsmtdad    Medical Terminology Daily (MTD) is a blog prepared by Clinical Anatomy Associates, Inc. as a service to the medical community, medical students, and the medical industry. We will post a workweek daily medical or surgical term, its meaning and usage, as well as biographical notes on anatomists, surgeons, and researchers through the ages. Be warned that some of the images used depict human anatomical specimens.

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A Moment in History 
Pare
Ambroise Paré
 
(1510 - 1590) 

French barber-surgeon.  He studied at the Hótel-Dieu, a hospital in Paris. In 1537 he started work as an army surgeon. At the time, the general belief was that gunshot wounds were poisoned by the gunpowder, so the standard procedure was to cauterize bleeding vessels with red hot irons and then burn the open wound with boiling oil. During a battle in Turin he ran out of oil, and in despair, tried to ease the pain and suffering of the soldiers that could not be treated "appropriately" by using the only elements available to him at the moment: a paste made with rose oil, turpentine, and egg yolks.

To his surprise, the soldiers thus treated recuperated faster and with less pain. Paré decided to treat his patients more humanely, and try to reduce pain as much as possible in this pre-anesthesia world. He started using ligatures instead of cautery, and soothing salves and pastes with clean bandages to promote healing.

Paré published several books and is considered by many the first modern surgeon.

Image courtesy of the US National Library of Medicine


 

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Corona Mortis

Important for inguinal hernia anatomy and surgery, this term is Latin from [corona] meaning "crown' and [mortis] meaning "death'; the "crown or circle of death". The corona mortis (blue arrow) refers to an anatomical variation1, a vascular anastomosis between the obturator and the external iliac vascular systems that passes over Cooper's pectineal ligament and posterior to the lacunar (Gimbernat's) ligament. 

In some cases, the corona mortis is the actual obturator artery that arises from the inferior epigastric artery instead of the internal iliac artery. It can also arise from the external iliac artery. In both cases, it has been called an "aberrant obturator artery". This could be a misnomer, as this anatomical variation can be present in up to 25% of the cases. When present, the corona mortis  can be injured when a surgeon looks to enlarge the femoral ring by opening the lacunar ligament. This vascular structure could even be endangered in a laparoscopic procedure for inguinal of femoral hernia repair and a staple or tack is driven blindly into the pectineal (Cooper's) ligament.

Corona Mortis (A)Image property of: CAA.Inc.Artist: M. Zuptich

Berberoglu states that "although these tiny anastomoses... have been described in classical anatomy textbooks, these texts neglect to mention that theses anastomoses can be life-threatening".

In some rare cases, the corona mortis (aberrant obturator artery) coexists with the normal obturator artery.  Although called a [corona], this anatomical structure is an incomplete circle. In the image, the [corona mortis] is labeled "A".

Sources:
1. Rusu et al: "Anatomical considerations on the corona mortis" Surg Radiol Anat (2010) 32:17–24
2. Berberoglu et al: "An anatomic study in seven cadavers and an endoscopic study in 28 patients" Surg Endosc (2001) 15:72-75