Prevalence and morphology of corona mortis: a systematic study with routine abdominopelvic computed tomography

This study aimed to investigate the prevalence, morphology, and anatomical characteristics of corona mortis (CMOR) using routine portal-phase contrast-enhanced abdominopelvic computed tomography (CT). Corona mortis is defined as the anastomoses between the external iliac and inferior epigastric vessels and the obturator vascular structures. Accidental injury of these vascular connections during surgical operations, or damage from pelvic trauma, can lead to difficult-to-control pelvic haemorrhages.

We conducted a retrospective review on 1,593 abdominopelvic CT scans performed between January and April 2023. Patients' demographics, CMOR prevalence, morphology, and measurements - including vessel diameter and distance from the pubic symphysis - were analysed. CMOR was classified using the Rusu classification system, and arterial and venous anastomoses were documented.

CMOR was identified in 49.3% of patients. Venous CMOR was observed in 34% of cases, and arterial CMOR was detected in 7.1%, with 5.8% of patients exhibiting combined arterial and venous anastomoses. Venous vessel diameters averaged 3.1 mm on the right and 3.2 mm on the left, with significant sex-based differences (p = 0.001). The distance from the pubic symphysis to venous CMOR averaged 63 mm. Most arterial anastomoses were Type 1-2 (89.4%), and venous anastomoses were predominantly Type 2-1 (72%).

Routine portal-phase CT effectively identifies and classifies CMOR, providing valuable preoperative information. Bilateral and contralateral anastomoses are frequent, highlighting the need for detailed anatomical evaluation to lessen surgical complications. Future studies could enhance detection via the use of advanced imaging techniques such as 3D reconstructions.