Sponsors   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

Theodor Billroth

Theodor Billroth
(1829-1894)

Christian Albert Theodor Billroth was born in Prussia, in the city of Bergen. After being considered a slow learner requiring tutoring at home, Billroth studied Medicine in Berlin. In 1860 he was appointed as Professor of Clinical Surgery.

He is well-know by the partial or subtotal gastric resection surgeries he pioneered. In 1881 he performed the first of what is now known as a "Billroth I" procedure. He was the first to perform a partial resection and anastomosis of the esophagus, as well as the first surgeon to excise a rectal cancer. He is considered one of the Masters of Surgery.

Billroth was also a gifted musician playing the violin and viola. Good friend with Johannes Bramhs, he was sometimes invited to conduct the Zurich Symphonic Orchestra.

The first Billroth I procedure was performed in 1881 in a 43 year old female. Besides the well-known Billroth I and Billroth II subtotal gastrectomies, there are several eponyms that carry Billroth's name. Billroth's concepts on gastrointestinal anastomoses paved the way for the invention of surgical staplers.

Source: "Christian Albert Theodor Billroth: Master of surgery" Kazi, RA; Peter, RE, J Postgrad Med March 2004 50:1, 82-83
Original imagecourtesy ofImages from the History of Medicine at nih.gov


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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