A Morphometric Study on Anatomic Characteristics of Corona Mortis in South Indian Population

Abstract

Introduction: The Corona Mortis or the “crown of death” is the vascular anastomosis between the external iliac and obturator vessels in the retropubic region. If injured accidentally during laparoscopic inguinal hernia repair and certain minimally invasive gynaecological procedures such as midurethral or pubovaginal sling, can result in inadvertent haemorrhage. Recognising the anatomic characteristics of the corona mortis vessel is needed in order to prevent bleeding catastrophe. Aim: To estimate the prevalence and location of corona mortis in South Indian population and to determine the frequency of occurrence and its morphometry in males and females. Materials and Methods: This was an observational cross- sectional study conducted between December 2020 to August 2021 in the Department of Anatomy, Rajarajeswari Medical College and Hospital, Bangalore, Karnataka, India. Dissection of 55 adult cadavers (42 male and 13 female hemipelvises) was performed and corona mortis was observed on pelvic surface of superior pubic ramus, number of venous and arterial anastomosis were noted and photographed. In addition to diameter of the anastomotic vessel, the distance of corona mortis vessel from the pubic symphysis was measured using electronic digital caliper. Demographic data was expressed as frequency and percentage and continuous data as mean and standard deviation. Z test and t-test were done using statistical software Statistical Package for the Social Sciences (SPSS) version 23.0 to deduce the results. A p-value of <0.05 was considered as significant. Results: The corona mortis was observed in 35 out of 55 specimens (63.64%). It was seen in 29 male (69%) and six female hemipelvises (46%). In all the specimens, venous anastomosis was observed between the obturator vein and inferior epigastric or external iliac vein. Consequently, in the present study all the determined corona mortis were venous. The mean distance of corona mortis vessel from the pubic symphysis was 5.26±1.2 cm in males and 5.63±0.94 cm in females with p-value= 0.48, thus the distance of the anastomotic vessel remains consistent in both the sexes. Furthermore, diameter of corona mortis vessel (greater than 1 mm) was measured in both the sexes and found to be statistically not significant. Besides there was incidental finding, aberrant obturator artery was more prevalent in females in comparison to males (p-value=0.013). Conclusion: Corona mortis was present in 63.64% of the South Indian population and no statistically significant difference was found in prevalence in males and females. The distance of corona mortis vessel and the diameter of the vessel was consistent in both males and females.