52 - Corona Mortis: A Case of Anatomical Variation and Its Clinical Significance

Poster Board Number: 52
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Abstract Body : Introduction: Corona mortis (“crown of death”) is a common variation of arterial branching in the iliac artery system. This term includes the variation of origin of obturator artery as well as the anastomosis between the inferior epigastric artery and obturator artery (the pubic branch). Several variants were described in the literature where the Corona mortis courses either medial to the femoral ring across the superior pubic ramus towards the obturator canal, or encircling the femoral ring above and along its medial margin. The variant with the course of the obturator artery/or pubic branch of the artery encircling the femoral ring is of particular concern in cases related to the femoral hernia repair as the potentially fatal bleeding may occur into the pelvic cavity. The artery may be iatrogenically injured in the totally extraperitoneal inguinal hernia repair operations as well.
Materials and methods: While performing a routine dissection in the anatomy lab on a female cadaver we have identified an arterial vessel coursing medially from the right and left external iliac arteries (bilaterally) and dividing into two branches. One coursing upwards – the inferior epigastric artery. Another coursing downwards across the superior pubic ramus towards the obturator canal. There were no other arterial vessel entering the obturator canal on either side. We have measured the length of the arteries with a string and ruler, and the diameter of the arteries at the origin and at the entrance to the obturator canal with a digital caliper.
Results: The length of the identified variant artery on the right was 52.00 mm, and on the left – 48.73 mm. The diameter of the right artery was 2.40 mm at the origin and 2.56 mm at the entrance to the obturator canal. On the left side the diameter of the artery at its origin was 2.24 mm and at the entrance to the obturator canal – 2.13 mm. The vessel that branches from external iliac on the right and gives the above-mentioned variant artery was 10.40 mm long and 3.02 mm in diameter on the right side, and 13.29 mm long and 3.56 mm in diameter on the left side.
Conclusion: We have identified a Corona mortis anatomical variation where the obturator artery originates as a common trunk together with the right inferior epigastric from the external iliac artery. The described variation was present bilaterally.
Significance: The prevalence of the arterial Corona mortis may reach as high as 17% in certain populations. The management of the complications due to the damage of the Corona mortis during surgical interventions may pose a challenge and may be life threatening. This constitutes a significant clinical importance of the described anatomical variation. Corona mortis should be an important teaching point in educating medical students.