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.