Placenta percreta masquerading as an acute abdomen.

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.