Corona mortis -: An anatomic study in seven cadavers and an endoscopic study in 28 patients

Background: The corona mortis is defined as the vascular connections between the obturator and external iliac systems. While detailed information on the arterial anastomoses in corona mortis is available, a complete description of the venous system is lacking. Although the tiny anastomoses behind the pubic symphysis between the obturator and external iliac arteries have been described in classical anatomy textbooks, these texts neglect to mention that these anastomoses can be life threatening. Attention needs to be paid to these anastomoses between the arterial and the venous system located over the superior pubic ramus during laparoscopic procedures. Methods: Fifty retroinguinal regions were dissected in seven cadavers and 28 patients. Results: During the dissections, a venous anastomosis on the superior pubic ramus was a consistent finding in 96% of cases. This vein coursed vertically to the inferior border of the superior pubic ramus and connected to the obturator vein. Accessory branches of the obturator artery were observed in only 8% of the dissections. The tiny connections between the obturator and external iliac arteries are less important, since their diameter is <1 mm. Conclusions: We have termed the venous connection between the external iliac and obturator veins over the superior pubic ramus "the communicating vein". This structure forms the corona mortis. Surgeons dealing with direct, indirect, femoral, or obturator hernias need to be aware of these anastomoses and their close proximity to the femoral ring. In classical anatomy textbooks, a description of the veins that form corona mortis is found less often than descriptions of the arteries. Since a venous connection is more probable than an arterial one, its importance must be appreciated by surgeons in order to avoid venous bleeding.