The Anatomy of Pelvic Corona Mortis Vessels in Black Africans: A Cadaveric study a descriptive cross sectional study carried out at the Human Anatomy lab in Moi University

Abstract

BACKGROUND-The ‘‘corona mortis’’ is an anatomical variant, an anastomosis between the obturator and the external iliac or inferior epigastric arteries or veins. It traverses the superior pubic ramus at a variable distance from the symphysis pubis to anastomose with the superficial network of vessels. The name ‘‘corona mortis’’ or crown of death testifies to the importance of this anatomic feature, as significant hemorrhage may occur if accidentally cut and it is difficult to achieve subsequent homeostasis. Attention needs to be paid to these anastomoses by surgeons performing pelvic and acetabular surgery and also general surgeons performing hernia repair or laparoscopic procedures. OBJECTIVE-To study incidence and anatomy of the corona mortis variant in the black African population in relation to side and gender. METHODOLOGY-Forty embalmed hemipelvices obtained from the Department of Human anatomy at Moi University were used for this descriptive cross sectional study. The cadavers were dissected at the preperitoneal area of the abdominal wall from inside to look for corona mortis.The medial and middle windows of the ilioinguinal approach were performed, as described by Letournel . Identification of vessels more than 2mm in diameter traversing the superior pubic ramus was done and dissected to the point of anastomosis. After identifying theaberrant obturator artery or vein, the distance from the pubic symphysis medially to the point where the aberrant vessel crosses the superior pubic ramus was measured using vernier calipers. Further the distance from the point where the corona mortis crosses the superior pubic ramus to the anastomosis with the superficial network of vessels was measured. Chi-Square test was used to compare the incidence of the corona mortis between males and females. The level of significant difference used was p < 0.05. The unpaired t-test was used to compare mean of incidences of corona mortis in males and females. RESULTS-Corona mortis was present in 38% (15 of 40). Of these, 47% were in men and 53% in women. The mean distance from the pubic symphysis to the point where the corona mortis traverses the pubic ramus was 53.2mm (arterial) and 54.3mm (venous).The mean distance from the pubic ramus to the point of anastomosis with the external iliac systems were 16.4mm and 11.5mm for the artery and vein respectively. Regarding the nature of connection, 2(13.4%) were purely arterial, 5(33.3%) were purely venous while 8(53.3%) had both .From the chi-square results it showed that there was no significant relationship between the gender and nature of connections or side of the pelvis; (χ 2 =.134, df=2 ; p>0.05). The Independent Samples t-Test showed that there was no significant difference in mean incidence of corona mortis between male and female specimens (t=.135, df= 13; p>0.05) CONCLUSION AND RECOMMENDATIONS-In pelvic and acetabular surgery, the corona mortis must be ligated or clipped to advance the dissection further along the pelvic brim and quadrilateral surface during the modified stoppa approach which enables access to the anterior wall, anterior column, and associated anterior column and posterior hemitransverse fractures, as well as certain both-column, T-shaped, and transverse fractures. General Surgeons who repair direct, indirect, femoral, or obturator hernias need to be aware of the incidence of the corona mortis.