Placenta Percreta Left in Situ Invades the Sigmoid Colon: a Case Report

Document Type : Case Report


1 Department of General Surgery, Saint George Hospital University Medical Center, University of Balamand, Beirut, Lebanon

2 Department of Pathology, Saint George Hospital University Medical Center, University of Balamand, Beirut, Lebanon

3 Department Obstetrics and Gynecology, Saint George Hospital University Medical Center, University of Balamand, Beirut, Lebanon


Background: abnormal placentation occurs when the placenta adheres to the myometrium, instead of the decidua leading to what is nowadays known as the accreta spectrum. Risk factors the accreta spectrum include uterine scarring mostly related to previous cesarean sections, previous curettage, previous manual removal of a retained placenta, and endometriosis . Having said this, the incidence of abnormal placental adherence has been increased tenfold over the last 50 years which parallels the increasing rates of cesarean sections. Abnormally adherent placenta is classified according to its degree of invasion of the myometrium. When the placenta penetrates completely through the full thickness of the myometrium, it is classified as placenta percreta that possibly involves adjacent structures. Pelvic structures mainly the urinary bladder and the rectum are the most commonly involved structure. Furthermore and to a lesser extent, small bowel and the sigmoid colon may be involved
Placenta percreta rarely invades pelvic or abdominal organs other than the urinary bladder or rectum. The optimal management of this condition is yet to be determined. For patients who wish to preserve their fertility uterine artery embolization has been employed in an attempt to decrease maternal morbidity and preserve fertility.
Case: Herein we present a case of 32 year old female patient presenting for low anterior resection of the colon due to invasion by placenta percreta left in situ.
Conclusion: Invasion of sigmoid colon by the placenta percreta left in situ as part of conservative management of placenta percreta has never been reported in the medical literature. Multidisciplinary approach for its management is optimal represented by interventional radiologist, urologist, colorectal surgeon and obstetrician.


  1. Clement PB, Young RH. Atlas of Gynecologic Surgical Pathology. Philadelphia, PA: Saunders Elsevier; 2014.
  2. Miller DA, Chollet JA, Goodwin TM. Clinical risk factors for placenta previa-placenta accreta. Am J Obstet Gynecol 1997; 177: 210-214.
  3. Wu S, Kocherginsky M, Hibbard JU. Abnormal placentation: twenty-year analysis. Am J Obstet Gynecol 2005; 192: 1458-1461.
  4. 4. Belfort M. Placenta accreta. Am J Obstet Gynecol. 2010; 203(5):430–9.
  5. Styron AG, George RB, Allen TK, Peterson- Layne C, Muir HA. Multidisciplinary management of placenta percreta complicated by embolic phenomena. Int J Obstet Anesth 2008; 17:262-6.
  6. Mathelier AC, Karachorlu K. Placenta previa and accreta complicated by amniotic fluid embolism. Int J Fertil Womens Med 2006;51: 28-32.
  7. Ochshorn A, David MP, Soferman N. Placenta previa accreta. A report of 9 cases. Obstet Gynecol 1969; 33: 677-679.
  8. Washecka R, Behling A. Urologic complications of placenta percreta invading the urinary bladder: a case report and review of the literature. Hawaii Med J 2002;61:66-9.
  9. O’Brien JM, Barton JR, Donaldson ES. The management of placenta percreta: conservative and operative strategies. Am J Obstet Gynecol 1996;175:1632-8.