Placenta percreta complicated by active bleeding detected on MRI: A case report

Placenta percreta is a potentially fatal condition characterized by abnormal placental invasion through the myometrium and serosa, sometimes extending into adjacent structures such as the urinary bladder or the bowel. We report a case of a 26-week pregnant woman referred for abdominal MRI to exclude appendicitis, in whom MRI unexpectedly demonstrated features of placenta percreta complicated by hemoperitoneum and possible active bleeding. MRI findings included engorged tortuous vascularity, multiple dark intraplacental T2 bands, multiple uterine bulging, and loss of the normal hypointense T2 uterine lining. Moderate hemoperitoneum was also identified. Emergency surgery confirmed placenta percreta with active extravasation, hemoperitoneum of approximately two litres, and bladder adhesions. Hysterectomy was performed, with bladder repair, and the patient recovered uneventfully. This case highlights the critical role of MRI in diagnosing placenta accreta spectrum (PAS), even when performed for unrelated indications. Recognition of hemoperitoneum and features suggestive of active extravasation should prompt urgent multidisciplinary intervention to optimize maternal outcomes.