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Placenta percreta masquerading as an acute abdomen
Luis E Roca1, M Camille Hoffman, Lucia F Gaitan
1From the Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, University of Miami School of Medicine/Jackson Memorial Hospital, Miami, Florida.
Background:
The incidence of placenta percreta has been on the rise during the past decades, coincident with the increase in cesarean deliveries. The diagnosis of this potentially life-threatening complication is difficult, especially when it masquerades as other severe complications of pregnancy.
Case:
A woman with one previous cesarean delivery presented at 28 weeks of gestation with right upper quadrant pain. Laparotomy revealed an intraperitoneal hemorrhage from a protrusion of the placenta at the previous uterine incision remote from the site of pain presentation. The fetus was delivered, and a hysterectomy was performed with subsequent good recovery. Pathology confirmed placenta percreta.
Conclusion:
The presentation of an acute abdomen with symptoms remote from the site of pathology in the third trimester masked the diagnosis of placenta accreta. When a clear diagnosis cannot be established, operative exploration must be considered.
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