Anatomical considerations on surgical implications of corona mortis: an Indian study

Abstract

The blood vessels traversing the superior pubic ramus are usually vascular connections between obturator and external iliac systems of vessels. Dislocated fractures or iatrogenic injury can cause life threatening bleeding and hence these vascular anomalies are referred to as corona mortis meaning ‘crown of death’. Except for a case report, no study on corona mortis has been attempted in India so far and hence the present study was intended at exploring the possible variations, both morphological and topographical, of these vascular connections in Indian population through cadaveric dissection. 24 adult cadavers dissected bilaterally (48 hemipelves) and 19 random hemipelves available in the Department of Anatomy were considered for the study.The vascular connections observed were classified as arterial, venous or both (Types I, II and III). Type III was further classified into subtypes a, b, c, d and e based on various combinations of the first two types. In a total of 67 pelvic halves corona mortis was detected in 56 (83.58%) specimens: arterial 7/56 (12.5%), venous 34/56 (60.7%) and both arterial and venous in 15/56 (26.78%) specimens respectively. 22 hemipelves had an artery on the superior pubic ramus out of which in 7 cases there was only an artery whereas in 15 cases both an artery and a vein were present. Commonest source of obturator artery was inferior epigastric artery 15/22 (68.18%) followed by external iliac artery 4/22 (18.18%). 49 of the 56 corona mortis positive specimens had a vein on the superior pubic ramus. In 34/56 specimens only a vein was present.12/49 (24.48%) veins drained into external iliac vein, 3/49 (6.12%) into inferior epigastric vein. A venous anastamosis was found between obturator vein and external iliac vein in 21/49 (42.85%) cases and between obturator and inferior epigastric vein in 10/49% (20.40%) cases. Corona mortis was observed in a significant percentage of specimens, venous corona mortis being more common than arterial. Every surgeon dealing with hernias or fractures of the region needs to be aware of the possible variations and ligate vessels if corona mortis presents itself or else it becomes difficult to control bleeding if a cut vessel retracts into the pelvis.