Acute abdomen in pregnant patient is always a situation of difficult diagnosis and management. Among the causes that may give rise to acute abdomen during pregnancy, adherent placentas, although their incidence is low. Adherent placentas include terms like placentas acretas, incretas and percretas, in relation to deepness of chorial villi invasion, but all of them share the same common characteristic, the absence of decidua between placenta and myometrium. This lack of decidua may be total or partial. The most frequent one is placenta acreta (1 between 18.000 pregnancies)(1). We present a case of placenta percreta, which presented with acute abdominal pain during the second trimester or the pregancy.

CLINIC CASE Female, 24 years old, with personal history of two eutocic deliveries without any complication. At 17th week of gestation she presented hipogastric pain, abdominal distention and dizziness. Physical examination showed abdominal distention, severe hypotension, cold extremities, slight obnubilation, pain at right flank, and scarce metrorrhagia. At echography, an 8-cm crown-rump length embryo was observed. Douglas sac showed abundant fluid compatible with hemoperitoneum. Urgent laparotomy was performed and hemoperitoneum was present, with a pregnancy uterus with a rupture located at right uterine horn that showed trophoblastic tissue emerging to the peritoneal cavity. There was no abnormality in the surrounding organs. Subtotal histerectomy with bilateral salpinguectomy was performed, preserving both ovaries. Postoperative period was in the normal limits, and a concentrate of red blood cells was administered. Pathology study showed a pregnancy uterus with rupture located in uterine fundus caused by placenta percreta.

Acute abdomen, pregnancy, placenta percreta.