Placenta percreta with small bowel invasion: unusual presentation of abnormal placental adherence

Abstract

Abnormal adherence of the placenta to the myometrium can lead to failure of normal postpartum placental separation. Owing to increasing rates of cesarean section, the incidence of morbidly adherent placenta has increased. Abnormally adherent placenta is classified according to its degree of invasion of the myometrium. When the placenta penetrates completely through the myometrium, it may result in placenta percreta, possibly involving adjacent structures or organs such as the urinary bladder or rectum. The urinary bladder is the most commonly affected pelvic structure, whereas the involvement of other abdominal organs by placenta percreta is an extremely rare condition. We describe a rare case of placenta percreta invading the terminal ileum and mesentery. A 40-year-old woman presented at 28 weeks of gestation with irregular uterine contraction and vaginal bleeding. She underwent a repeat cesarean section and explorative laparotomy. Segmental resection of the perforated terminal ileum was performed. Histopathological examination revealed an adherent placenta with invasion of the chorionic villi into the ileal subserosa and mesentery. The trophoblastic origin was confirmed by immunohistochemistry. Placenta percreta is associated with high maternal mortality and morbidity rates, mostly secondary to intraoperative bleeding and its consequences. A high index of suspicion for placenta percreta is required when evaluating pregnant women with a prior history of cesarean section. Ultrasonography and magnetic resonance imaging may assist in establishing the diagnosis preoperatively. With proper planning and a multidisplinary approach, fetal and maternal morbidity and mortality may be decreased.