Case report: pre-surgical embolization of the Corona Mortis in a patient with multiple pelvic fractures. A tool to avoid perioperative bleeding?

Background: The Corona Mortis is an anatomical vascular variant representing an anastomosis between the external iliac and obturator vessels. It is present in approximately 63% of the population. If injured, either due to pelvic trauma or during surgical procedures, it can lead to significant and potentially life-threatening hemorrhage. Iatrogenic injury is most commonly encountered during orthopedic procedures such as inguinal or femoral hernia repairs, hip fracture fixation, and various gynecological surgeries. Preoperative endovascular embolization of the Corona Mortis may serve as a valuable strategy to avoid perioperative bleeding. Case Presentation: A 72-year-old man presented after trauma with complex right acetabular and femoral head fractures, along with ipsilateral iliopubic and ischiopubic branch fractures. CT angiography revealed extensive extraperitoneal bleeding and the presence of a right-sided Corona Mortis (1.9 mm), arising from the inferior epigastric and anastomosing with the obturator artery. Based on this finding, the orthopedic team requested pre-surgical embolization to enable a safer surgical intervention. Conclusion: The Corona Mortis represents a significant but often underrecognized source of pelvic bleeding. Preoperative angiographic identification, followed by prophylactic embolization when appropriate, can substantially reduce perioperative hemorrhagic risk. In the event of iatrogenic injury, endovascular techniques offer an effective, minimally invasive alternative to open surgical intervention, improving patient outcomes and reducing procedural morbidity.