Anomalous origin of the obturator artery in a Goan population: A study linked with hernia reduction surgery

Abstract

Introduction: The “corona mortis” or “crown of death” occurs when an accessory obturator artery (OA) is also present, having rich anastomosis with the normal OA around the obturator canal. The OA can take origin from various arteries such as the common iliac, anterior or posterior divisions of the internal iliac, inferior epigastric, superior or inferior gluteal, internal pudendal, or even external iliac arteries. Accessory OA has an incidence of 30%–40% in earlier studies.To find out the incidence, location, and dimensions of aberrant, retropubic, anastomosing vessels and the corona mortis that connects the external iliac and obturator vessels and to determine their interference with various surgical approaches. Material and Methods: Twenty-five cadaveric pelvises were dissected in the pelvic and retropubic inguinal regions. The origin and course of the OA and the presence of venous plexuses were recorded. We studied the frequencies of occurrence of abnormal obturator vessels and also their variant patterns of origin from and drainage into the iliac vessels. Student's t-test was the statistical analysis used. Results: We found a higher incidence, i.e., 44% of internal iliac artery branching pattern as Group Ia. Vasa corona mortis was seen in two pelvises showing an arterial connection around the superior pubic ramus, whereas venous corona mortis was seen in twenty pelvises and five hemipelvises showing an aberrant OA. Discussion and Conclusions: Cadaveric dissections have shown a vascular connection between the obturator, external iliac, and inferior epigastric vessels, and these variations are important specially when doing pelvic and groin surgeries.