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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 Moment in History

Dr. John Benjamin Murphy


Dr. John Benjamin Murphy
(1857 – 1916)

An American surgeon, John Benjamin Murphy was born in Appleton, Wisconsin in 1857. He studied anatomy and physiology in Appleton under the care of Dr. H.W. Reilly, a local physician, after which J.B. Murphy entered the Rush Medical College, receiving his degree in 1879.  

Urged by the new trends in surgery and antisepsis, in 1882 Dr. Murphy he traveled to Vienna to study with Theodor Billroth (1829 – 1894), and then on to Heidelberg and Berlin. Upon his return, he started great advances in the surgery of the time. One of them was to propose the immediate extirpation of the vermiform appendix when acute appendicitis was diagnosed, as opposed to the common practice of waiting until the vermiform appendix ruptured. 

In 1892 Dr. Murphy became professor of clinical surgery at the College of Physicians and Surgeons in Chicago. Dr. Murphy is one of the founders of the American College of Surgeons. His surgical endeavors span many specialties including abdominal, thoracic, peripheral vascular, orthopedics, neurosurgery, etc. 

One of his well-known inventions was a metal sutureless compression anastomotic device, known to many as the “Murphy button”. Although in 1826 Denans and Henroz had created metal compression anastomotic devices with a similar concept, Murphy’s improvements on the device caused it to be used well into the 1900’s. The reason for this is the support the device had from the Mayo brothers, founders of the today well-known Mayo Clinic. Although not a stapler, the Murphy button established the need for anastomotic leakage control and the possibility of and end-to-end anastomosis. This makes Dr. Murphy's concept part of the history of surgical stapling. For an image of the Murphy anastomotic device click here, the link is courtesy of the Museum of Health Care at Kingston, Canada.

Murphy’s first use for his device was for a cholecystojejunostomy, the anastomosis of the gallbladder to the jejunum to allow drainage of the bile into the digestive system. 

His name is remembered in many eponyms: Murphy’s button, Murphy’s drip, Murphy’s test, Murphy’s punch, and the Murphy-Lane bone skid.

Sources: 1. “Cholecystointestinal, gastrointestinal, enterintestinal anastomosis, and approximation without sutures” Murphy JB. Med Rec (1892) 42: 665
2 . “John Benjamin Murphy – Pioneer of gastrointestinal anastomosis” Bhattacharya, K., & Bhattacharya, N. (2008). Indian J. Surg., 70, 330-333.
3. “The Story of Surgery” Graham, H. (1939) New York: Doubleday, Doran & Co.. Inc.
4. “Compression Anastomosis: History and Clinical Considerations”Kaidar-Person, O, et al, e. (2008) Am J Surg, 818-826.
5. “Current Practice of Surgical Stapling” Ravitch, M. M., Steichen, F. M., & Welter, R. (1991) Philadelphia: Lea& Febiger.
6.
“Rese¤as Históricas: John Benjamin Murphy” Parquet, R.A. Acta Gastroenterol Latinoam 2010;40:97


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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