Three cancers in the renal pelvis,bladder,and colon:A case report

BACKGROUND Multiple primary cancers are rare occurrences that can involve either metachronous or synchronous development.It is particularly rare for an individual to have more than two primary cancers.In this report,we present a case study of an elderly man who was diagnosed with three heterochronous cancers in the renal pelvis,bladder,and colon.CASE SUMMARY On December 30,2014,a 51-year-old Chinese man was admitted to our hospital with complaints of intermittent painless gross hematuria for the preceding week.A computed tomography(CT)scan revealed wall thickening in the left ureter’s upper segment,while a CT urography revealed a left renal pelvis tumor.A successful laparoscopic radical resection of the left renal pelvis tumor was subsequently performed at Shanghai Zhongshan Hospital in January 2015.The pathological findings after the surgery revealed a low-grade papillary urothelial carcinoma of the renal pelvis.The final pathological tumor stage was pT1N0M0.After surgery,this patient received 6 cycles of intravenous chemotherapy with gemcitabine and carboplatin,as well as bladder infusion therapy with gemcitabine.On December 18,2017,the patient was admitted once again to our hospital with a one-day history of painless gross hematuria.A CT scan showed the presence of a space-occupying lesion on the posterior wall of bladder.Cystoscopic examination revealed multiple tumors in the bladder and right cutaneous ureterostomy was performed under general anesthesia on December 29,2017.The postoperative pathological findings disclosed multifocal papillary urothelial carcinoma of the bladder(maximum size 3.7 cm×2.6 cm).The bladder cancer was considered a metastasis of the renal pelvis cancer after surgery.The pathological tumor stage was pT1N0M1.The patient refused chemotherapy after surgery.After another six years,the patient returned on February 28,2023,complaining of periumbilical pain that had lasted six days.This time,a CT scan of the abdomen showed a tumor in the ascending colon,but a subsequent colonoscopy examination indicated a tumor in the descending colon.On March 12,2023,a subtotal colectomy and an ileosigmoidal anastomosis were carried out under general anesthesia.Postoperative pathological findings revealed that all three tumors were adenocarcinomas.The final pathological tumor stage was pT3N0M0.The patient had an uneventful postoperative recovery and was discharged without complications.CONCLUSION The case of this elderly man presents a rare occurrence of metachronous primary cancers in the renal pelvis and colon.Bladder cancer is considered a metastasis of renal pelvis cancer after surgery.Optimal treatment can be implemented by evaluating the patient’s histological features,clinical history,and tumor distribution correctly.

Early diagnosis of renal pelvis villous adenoma:A case report

BACKGROUND Villous adenoma is a rare tumor in the urinary system that usually occurs in the bladder.It is extremely uncommon in the renal pelvis.Most of the previously reported cases have been diagnosed with severe hydronephrosis associated with renal parenchyma atrophy prior to surgery.Because of its rarity,available information on the pathogenesis,diagnosis,treatment and prognosis of the disease is limited.We reported a case of kidney stones with hydronephrosis.During percutaneous nephroscopic lithotripsy,a renal pelvis tumor was found.Biopsy confirmed that the tumor was a villous adenoma of the renal pelvis.CASE SUMMARY A 68-year-old female was admitted to the hospital due to right kidney stones with right hydronephrosis.After admission,a urinary system plain computed tomography scan was performed,which revealed right kidney stones with right hydronephrosis and right upper ureteral dilatation.Multiple new cauliflower-like papillary masses were then discovered in the renal pelvis and calyces during right percutaneous nephroscopic lithotripsy.Biopsy results indicated villous adenoma with high-grade glandular intraepithelial neoplasia.The patient underwent laparoscopic radical resection of the right kidney and ureter.Based on histopathological and immunohistochemical examination,the patient was diagnosed with villous adenoma without adenocarcinoma.CONCLUSION Villous adenoma is rare in the urinary system.We reported a case of renal pelvis villous adenoma,which may provide useful information for the early diagnosis and treatment of this tumor.

Renal pelvis sarcomatoid carcinoma with renal vein tumor thrombus:A case report and literature review

BACKGROUND Renal pelvis sarcomatoid carcinoma(RPSC)is a rare and aggressive malignancy whose diagnosis is difficult because radiological imaging results can lead to misclassification as a more common type of renal tumor.In addition,clinical management of patients with RPSC is difficult because of the limited efficacy of available treatments.In this study,we present a comprehensive description of a patient who presented with RPSC and a simultaneous renal vein tumor thrombus.CASE SUMMARY During April,2020,a 64-year-old female presented with an isolated episode of hematuria accompanied by abdominal pain.Computed tomography(CT)and magnetic resonance imaging(MRI)showed a lesion in the right renal pelvis.We therefore performed a radical nephrectomy of the right kidney.The subsequent histopathological and immunological results verified the diagnosis of RPSC.Despite administration of 6 cycles of a gemcitabine-cisplatin regimen,the patient's condition progressively deteriorated,and she died about 15 mo after the nephrectomy.CONCLUSION We performed a comprehensive analysis of a patient with RPSC that included CT,MRI,immunohistochemistry,and genetic testing.The insights from our detailed analysis of this patient and our concomitant review of the literature may assist clinicians in their diagnosis and treatment of RPSC.

Reduced Imaging Time and Improved Image Quality of 3D Isotropic T2-Weighted Magnetic Resonance Imaging with Compressed Sensing for the Female Pelvis

This study is to compare three-dimensional(3D)isotropic T2-weighted magnetic resonance imaging(MRI)with compressed sensing-sampling perfection with application optimized contrast(CS-SPACE)and the conventional image(3D-SPACE)sequence in terms of image quality,estimated signal-to-noise ratio(SNR),relative contrast-to-noise ratio(CNR),and the lesions’conspicuous of the female pelvis.Thirty-six females(age:51,28-73)with cervical carcinoma(n=20),rectal carcinoma(n=7),or uterine fibroid(n=9)were included.Patients underwent magnetic resonance(MR)imaging at a 3T scanner with the sequences of 3D-SPACE,CS-SPACE,and twodimensional(2D)T2-weighted turbo-spin echo(TSE).Quantitative analyses of estimated SNR and relative CNR between tumors and other tissues,image quality,and tissue conspicuity were performed.Two radiologists assessed the difference in diagnostic findings for carcinoma.Quantitative values and qualitative scores were analyzed,respectively.The estimated SNR and the relative CNR of tumor-to-muscle obturator internus,tumor-to-myometrium,and myometrium-to-muscle obturator internus was comparable between 3D-SPACE and CS-SPACE.The overall image quality and the conspicuity of the lesion scores of the CS-SPACE were higher than that of the 3D-SPACE(P<0.01).The CS-SPACE sequence offers shorter scan time,fewer artifacts,and comparable SNR and CNR to conventional 3D-SPACE,and has the potential to improve the performance of T2-weighted images.

A Case Report: High-Grade Urothelial Carcinoma in the Renal Pelvis with Complete Kidney and Ureter Duplication Featuring Heterologous Differentiation

This report describes a considerably rare case of high-grade urothelial carcinoma of the renal pelvis and ureter,presenting with heterologous differentiation,in a patient with bilateral duplicated kidneys.A 73-year-old male experienced intermittent gross hematuria for 5 months,accompanied by lower back and abdominal pain.Ultrasound and computed tomography scans revealed bilateral renal and ureteral duplication with multiple tumors in the left renal pelvis.A total nephroterectomy and bladder cuff resection were performed on the left two nephrons.Multiple space-occupying lesions were identified in the left renal pelvis and ureter.Histopathological examination showed poorly differentiated and diverse tumor cells,manifesting as sarcomatoid carcinoma,papillary adenocarcinoma,and infiltrating high-grade urothelial carcinoma.The tumor infiltrated the subcutaneous fibrous connective tissue of the renal pelvis and the full thickness of the ureter.Given the rarity of recurrent renal urothelial carcinoma with heterogeneous differentiation,comprehensive imaging and pathological assessments are vital to delineate the nature of the lesion and the direction of tissue pathological heterologous differentiation.These evaluations guide early radical surgical interventions,improving survival rates.

Research Progress of Assessment Tools for Peripheral Venous Access Difficulties in Children

Objective:To review the research progress of peripheral venous access difficulty assessment tools in children and to provide a reference for clinical nurses to select and develop appropriate assessment tools.Methods:Search the literature at home and abroad and summarize and analyze the existing evaluation tools.Results:There is no unified assessment tool about difficult venous access in children at home and abroad.The existing tools include the difficult venous access assessment scale and peripheral venous grading assessment tool.Conclusion:The current assessment tools for venous access difficulties in children have their own limitations,and it is necessary to develop further the assessment tools suitable for the cultural background of children's venous access difficulties.This paper summarized the current progress of research on peripheral venous access difficulty assessment tools.It also analyzed and summarized the shortcomings of existing tools to provide a reference for clinical staff to choose appropriate assessment tools.

Patterns of peritoneal spread of tumor in the abdomen and pelvis

The spread of tumor in the peritoneum can be understood, although it is a complex organ. A study of its embryology, anatomy and function is of clear benefit. It is formed from a network of folds, reflections, and potential spaces produced by the visceral and parietal peritoneum. These folds and reflections begin as a dorsal and ventral mesentery, supporting the primitive gut in early embryologic development. The dorsal mesentery connects the stomach and other organs to the posterior abdominal wall, while the ventral mesentery connects the stomach to the ventral abdominal wall. As the embryo develops, there is further organ growth, elongation, cavitation and rotation. The dorsal and ventral mesentery also develops along with the viscera, forming ligaments, mesenteries, omenta and potential spaces from the resulting reflections and folds. These ligaments, mesenteries, and omenta, support and nurture the organs of the peritoneum, providing a highway for arteries, veins, nerves and lymphatics. The potential spaces created from these folds and reflections of the visceral and parietal peritoneum are also important to realize. For example, the transverse mesocolon divides the peritoneal cavity into a supramesocolic and inframesocolic space in the abdomen and paravesicular spaces within the pelvis. The falciform ligament is well known in the supramesocolic space, dividing it further into a left and right compartment. Knowledge of the peritoneal vascular anatomy is beneficial in locating the spaces and ligaments about the peritoneum. For example, identifying the left gastric artery or vein will lead to the gastrohepatic ligament, which is part of the supramesocolic space. Besides serving a life sustaining role, the multiple compartments, ligaments, mesenteries and omenta within the peritoneum can also facilitate the spread of disease. Tumors can spread directly from one organ to another, seed metastatic deposits in the peritoneal cavity, and travel through the lymphatic or hematogenous route to invade other organs in the peritoneum.

Spontaneous rupture of the renal pelvis presenting as an urinoma in locally advanced rectal cancer

A 29-year-old gentleman underwent a transverse colostomy for intestinal obstruction caused by advanced rectal carcinoma. On the 5th postoperative day, the patient developed a painful swelling on the right side of the abdomen. The contrast enhanced computed tomography of the abdomen revealed a right sided hydronephrosis, a large rent in the renal pelvis, and a large retroperitoneal fluid collection on the right side. Percutaneous nephrostomy and pigtail catheter drainage of the urinoma led to resolution of abdominal swelling. Development of a urinoma as a consequence of rectal carcinoma is highly unusual. Prompt imaging for confirmation of diagnosis, decompression of the renal pelvicalyceal system, and drainage of the urinoma limits morbidity.

Carcinomas of the renal pelvis and ureter:a clinicopathological study of 63 cases with a review of literature

Objective： The aim of this study was to summarize the clinicopathological characteristics of patients with renal pelvis and ureteral carcinomas, and analyze the recurrence in the remaining urinary tract and metastasis outside the urinary tract after surgical treatment. Methods： The patients＇ characteristics, tumor stage and grade, recurrence and metastasis distribution were summarized by tables, respectively. Spearman rank test, Log-rank test, Kaplan-Meier survival curve, and Cox proportional hazards regression model were used to make statistical analysis. Results： A total of 63 patients with 30 men, 33 women, 30 renal pelvic tumors and 33 ureteral tumors was found. Seven had muttifocal lesions. Fifty-four underwent surgical operation, which contained 49 cases of pathologically confirmed transitional cell carcinoma, 4 transitional cell carcinoma with squamous differentiation, and 1 squamous cell carcinoma. Tumor stage and grade had positive correlation. Among the 34 followed-up cases, 21 had no metastasis, 10 had metastasis, in which stage T3-4 groups accounted for 90%, and 5 developed tumor recurrences. The metastasis-free survivals had no significant difference between renal pelvic carcinoma and ureteral carcinoma, but had significant difference between high, middle and low stage groups, and between high and low grade groups. Conclusion： The incidence rates of the renal pelvic carcinoma and ureteral carcinoma is similar and no gender difference. Multifocal lesions can be seen Jn any stage and grade, but this is not necessarily a symbol of poor prognosis. The bladder recurrences is often seen in the cases with initially multifocal lesions or lesions in the middle or lower portion of the ureter. The prognosis is good after resection of the recurrence lesion. The prognosis get worse with the increasing stages and grades. Stage is the main factor to influence the survival. Metastasis outside the urinary tract is often seen in patients with high stage tumors.

Primary follicular lymphoma in the renal pelvis:A rare case report

BACKGROUND Follicular lymphoma(FL)is more common in lymph nodes,while primary extranodal lymphomas are rare.Urinary tract lymphoid neoplasms are extremely rare,accounting for less than 5%of all extranodal lymphomas.Only one case of FL from the renal pelvis has previously been reported.CASE SUMMARY A 70-year-old male patient with a history of esophageal cancer visited our hospital for follow-up examination.Abdominal computed tomography revealed a malignant mass in the right renal pelvis.The whole-body positron emission tomography/computed tomography showed a significant increase in fluorodeoxyglucose uptake of this soft tissue mass and no abnormal fluorodeoxyglucose uptake in the esophageal wall.The patient underwent radical resection of a malignant tumor in the right kidney,which was confirmed by postoperative pathology to be FL.The patient received no radiation or chemotherapy after surgery,and no recurrence of lymphoma or other malignant tumors was found at the 1-year follow-up.CONCLUSION Extranodal FL is more common in the skin and gastrointestinal tract but rarely occurs in the urinary tract.This is the second report of primary renal FL.Localized extranodal FL is expected to have a favorable prognosis and can be cured by local resection.

Spectrum of mucin-producing neoplastic conditions of the abdomen and pelvis:Cross-sectional imaging evaluation

Various mucin-producing neoplasms originate in different abdominal and pelvic organs.Mucinous neoplasms differ from non-mucinous neoplasms because of the differences in clinical outcome and imaging appearance.Mucinous carcinoma,in which at least 50%of the tumor is composed of large pools of extracellular mucin and columns of malignant cells,is associated with a worse prognosis.Signet ring cell carcinoma is characterized by large intracytoplasmic mucin vacuoles that expand in the malignant cells with the nucleus displaced to the periphery.Its prognosis is also generally poor.In contrast,intraductal papillary mucinous neoplasm of the bile duct and pancreas,which is characterized by proliferation of ductal epithelium and variable mucin production,has a better prognosis than other malignancies in the pancreaticobiliary tree.Imaging modalities play a critical role in differentiating mucinous from non-mucinous neoplasms.Due to high water content,mucin has a similar appearance to water on ultrasound(US) ,computed tomography(CT) ,and magnetic resonance imaging,except when thick and proteinaceous,and then it tends to be hypoechoic with fine internal echoes or have complex echogenicity on US,hyperdense on CT,and hyperintense on T1and hypointense on T2-weighted images,compared to water.Therefore,knowledge of characteristic mucin imaging features is helpful to diagnose various mucinproducing neoplastic conditions and to facilitate appropriate treatment.

Retroperitoneal laparoscopic partial resection of the renal pelvis for urothelial carcinoma:A case report

BACKGROUND The standard treatment of transitional cell carcinoma of the upper urinary tract consists of radical nephroureterectomy with bladder cuff removal,which can be performed either in open or laparoscopy or robot-assisted laparoscopy.Treatment of chronic renal insufficiency patients with upper urothelial tumor is in a dilemma.Urologists weigh and consider the balance between tumor control and effective renal function preservation.European Association of Urology guidelines recommend that select patients may benefit from endoscopic treatment,but laparoscopic treatment is rarely reported.CASE SUMMARY In this case report,we describe a case of 79-year-old female diagnosed with urothelial carcinoma of the renal pelvis and adrenal adenoma with chronic renal insufficiency.The patient was treated with retroperitoneal laparoscopic partial resection of the renal pelvis and adrenal adenoma resection simultaneously.CONCLUSION Retroperitoneal laparoscopic partial resection of the renal pelvis is an effective surgical procedure for the treatment of urothelial carcinoma of the renal pelvis.

Chylous ascites after whole pelvis suspension:case report and literature review

We report a case of Chylous ascites after whole pelvis suspension and to discuss the possible reasons. An 85-year-old female patient with anterior vaginal prolapse 1V （AVP IV）, vaginal vault proplapse IV and posterior vaginal prolapse IV （PVP IV）, developed Chylous ascites 2 weeks after she received whole pelvis suspension, The cause of chylous ascites in the present case was not associated with malignant tumor, hepatic cirrhosis, or inflammation. Therefore, surgical trauma may be considered the cause of disorder. X-ray lymphangioadenography should be performed to draw a final conclusion.

Pyonephrosis as a sign of sarcomatoid carcinoma of the renal pelvis

We report the case of an urgent nephrectomy because of a pyonephrosis and sepsis due to an unsuspected sarcomatoid transitional cell carcinoma, an infrequent subtype with a bad oncological prognosis. We present a 58-year-old man assessed by internal medicine for a general syndrome and weakness many months previously. A pyonephrotic kidney was observed at abdominal computed tomography in the context of septic shock, without suspecting the underlying cause. The pathology report described a sarcomatoid transitional cell carcinoma. Sarcomatoid transitional cell carcinoma is an invasive and infrequent subtype of urothelial tumors. The symptoms are often the same as other renal masses; however, in this case, sepsis and pyonephrosis were the rare initial symptoms.

Melanoma metastases in the abdomen and pelvis: Frequency and patterns of spread

AIM: To investigate the frequency, typical and atypical locations and patterns of melanoma metastases identifiable by computed tomography (CT) in the abdomen and pelvis. METHODS: We performed a retrospective review of index CT examinations of the abdomen and pelvis in patients with melanoma and recorded all findings suggestive of metastatic disease. RESULTS: Metastases were present on 36% (181/508) of the index examinations and most commonly involved the liver (47%) and pelvic lymph nodes (27%). Lower extremity primaries had the highest rate of metastasis (52%). Ocular and head and neck melanomas have a predilection to metastasize to the liver (hepatic involvement in 70% and 63%, respectively, of patients with metastatic disease) and metastases from lower extremity primaries most commonly involve pelvic lymph nodes (54% of patients with metastatic disease). Metastases to atypical locations were present in 14% of patients and most commonly occurred in the subcutaneous tissue and spleen. Primary tumors of the lower extremity, back and head and neck were most commonly associated with atypical metastases. Pelvic metastases are more common with lower extremity primaries (accounting for 70% of cases with pelvic metastases) but 5% of patients with supraumbilical primaries also had pelvic metastases. CONCLUSION: The distribution of metastatic melanoma in the abdomen and pelvis that we have defined should help guide the interpretation of CT exams in these patients.

Planning Margins to CTV for Image-Guided Whole Pelvis Prostate Cancer Intensity-Modulated Radiotherapy

Purpose: We investigated the margin recipes with different alignment techniques in the image-guided intensity-modulated radiotherapy (IMRT) of whole pelvis prostate cancer patients. Materials and Methods: Forty-eight computed tomography (CT) scans of eight prostate cancer patients were investigated. Each patient had an initial planning CT scan and 5 consecutive serial CT scans during the course of treatment, all of which were acquired using 3 mm slice separation and 0.94 mm resolution in the axial plane at 120 kVp, on a PQ 5000 CT scanner. Three different whole pelvis planning margin recipes, ranging from 3 to 13 mm, were investigated. A unique IMRT plan was created with each PTV on the initial CT scan, and was then registered to the 5 serial CT scans, by bony alignment or by prostate gland-based alignment. The dose computed on each serial CT scans was accumulated back to the initial CT scan using deformable image registration for final dosimetric evaluation of the interplay of the margin selection and alignment methods. Results: Bony alignment and prostate gland-based alignment gave very similar result to the pelvic lymphatic nodes (PLNs), regardless of its margin around. The prostate gland-based alignment greatly enhanced the coverage to the prostate and SV, especially with small margins. Meanwhile, the soft-tissue alignment also raised the incidental dose to the rectum and reduces the dose to the bladder. With small to intermediate margins, only soft-tissue alignment gave acceptable mean coverage to SV. Margin of 13mm or more was needed for PLNs to maintain good target coverage. Conclusion: We commend prostate-based alignment along with margins less than or equal to 5mm around prostate and SV, and margins greater than or equal to 13 mm around the vascular spaces.

Long Term Progression Free Survival Achieved by Maintenance “Second–Line” Polychemotherapy with Gemcitabine/Paclitaxel in Metastatic Urothelial Cancer of the Renal Pelvis—A Case Report

Moderate activity of systemic chemotherapy for advanced urothelial cancer has been reported for more than 30 years. Only with the advent of potent combination therapy clinically significant response rates as well as prolonged survival were documented. The therapeutic effect of a “second-line” polychemotherapy in metastatic upper tract urothelial cancer is largely unknown caused by the small number of cases and poor prognosis. We report an interesting case of a 59-year-old man suffering from urothelial cancer of the renal pelvis with pulmonary, lymphogenic and bone metastases who showed an unexpected response to a “second-line”chemotherapy after only 2 treatment cycles of Gemcitabine/Paclitaxel (partial remission) after 24 treatment cycles Gemcitabine / Cisplatin in “stable disease” and progression between the treatment intervals. We performed maintenance “second-line” therapy for 24 cycles and the patient showed a remarkable persisting response 54 months after operation.

Symptomatic Pelvic Kidney in Women at Childbearing Potential: Diagnostic Difficulties and Management in Urology Department of N’Djamena in Chad

Introduction: We aim to report, from three observations, the diagnostic difficulties and complications, and ensure the management of pelvic kidney in women at childbearing age in the Urology Department of the National General Referral Hospital of N’Djamena. Pelvic kidney is due to an abnormality of the migration that can be associated or not with a malrotation. Its symptomatology is not specific, causing diagnostic difficulties and therapeutic errors. Observation: There were three observations of female patients aged respectively 26, 29 and 32 years who were taken care of for years in the gynecology department for pelvic inflammatory disease before being routed in urology. The diagnosis of pelvic kidney was retained on the basis of morphological examination (ultrasound, intravenous urography, CT urography). The patients have undergone nephrectomy;the postoperative aftermath was simple. Conclusion: Pelvic kidney is a rare disease. It is often discovered during autopsy. Symptoms are non-specific;nephrectomy is the treatment of choice in symptomatic cases.

What Is the Association between an Anteriorly Tilted Pelvis and Trendelenburg Gait?

Lower back pain (LBP) is a widespread, painful medical condition that has been plaguing society for many years. Present conservative rehabilitation focus is on lumbo-pelvic hip stability exercises in individual planes. However, a functional integrative rehabilitative approach addressing lumbo-pelvic misalignment in the sagittal (anteriorly tilted pelvis) and frontal (Trendelenburg gait) planes has not been presented. The aforementioned patho-biomechanical conditions and their management are often discussed estranged from each other rather than functionally integrated. This paper serves as a short communication which discusses the lumbo-pelvic anatomy, identifies the anatomical and biomechanical associations between the anteriorly tilted pelvic and Trendelenburg gait. Through an analysis of relevant literature, recommendations were made on the improvement of flexibility of the hip flexors, taut iliofemoral and pubofemoral ligaments to resolve the primary abnormal force-couple, with improved flexibility of the erector spinae and quadratus lumborum to resolve the secondary abnormal force-couple. In addition, improved flexibility of the hip flexors should coincide with closed-kinetic chain concentric strengthening of the ipsi-lateral hip abductors and contralateral external obliques. Patient education is also needed for self-re-alignment of the lower extremity to a neutral position and neutral foot stance. Biokineticists/exercise therapists should also review the patient’s gait biomechanics to determine whether sartorius synergistic dominance is in play. In conclusion, the association between an anteriorly tilted pelvis and Trendelenburg gait, is in regard to taut anterior acetabulofemoral ligaments and femoral retroversion torsion angle that is both preceded and followed by the biomechanical influence of various anatomical structures. These anatomical and biomechanical factors must be evaluated by the biokineticists/exercise therapists before prescribing a rehabilitative programme to ensure successful rehabilitation of lumbo-pelvic hip complex.

Anatomical and Clinical Implication of Corona Mortis in the Anterior Approaches of Pelvis in Sudanese Patient

Background: Corona Mortis is an abnormal blood vessels connecting Between obturator and external iliac systems of vessels and inferior epigastric vessels. It is located behind the superior public ramus at a variable distance from the symphysis pubis. Orthopaedic surgeons and obestitrtion found these vessels in the field of surgery. So displaced fractures or iatrogenic injury, can cause life threatening bleeding and hence these vascular anomalies are referred to us crown of death. The bulk of the studies about the corona mortise were conducted in the cadavers or 3D CT angiography and there was no studies were conducted about corona mortise in Sudan. The purpose of this study was to study the corona mortis anatomical and clinical implication in the anterior approaches to the pelvis and acetabulum in Sudanese patient. Methodology: Hospital based descriptive cross-sectional study was conducted among patients sustaining anterior pelvic anterior acetabulum fracture and underwent open reduction internal fixation by reconstruction plates. This study was conducted in Bahri Teaching Hospital from June 2017 to June 2018. Through the most common anterior approaches to the pelvis and acetabulum (Stoppa-modified stoppa-ilioinguinal), done by single surgeon and fulfil data sheet intra-operatively. Results: In a total of 30 pelvic halves corona mortis was detected in 13 patients (43%).The Majority in the Rt.hemipelvies 7 (53.8%) specimens: arterial 4/13 (30.8%), venous 1/13 (7.7%) and both arterial and venous in 8/13 (61.5%) specimens respectively. Of these (53.9%) had a large Diameter > 5 mm and the largest one measure 80 mm, with mean distance From the symphysis 5.8 + 1.6 mm. Conclusion: Only 13 patients have corona mortis, 12 of them were arterial with diameter more than 5 mm (53%), and thus surgeon should exercise caution during Surgery and secure its site to help minimizing surgery time, Clear surgical field and prevent iatrgenic injury.