Universität zu Köln

Saleh, Mohamed M., Mallmann, Michael R., Essakly, Ahlem, Drebber, Uta, Kleinert, Robert, Kuetting, Fabian, Bratke, Grischa ORCID: 0000-0002-5696-9828 and Mueller, Annette M. (2022). Placental Invasion into the Small Bowel Intestine Through a Myomectomy Scar: A Case Report With Literature Review. Int. J. Gynecol. Pathol., 41 (2). S. 151 - 157. PHILADELPHIA: LIPPINCOTT WILLIAMS & WILKINS. ISSN 1538-7151

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Abstract

Although extremely rare, uterine damage after hysteroscopic myomectomy sets the precondition for various life-threatening placental attachment disorders like placenta percreta (PP) or scar pregnancy. Due to vast clinical similarities, these terms are often used interchangeably. We report a case of a 47-yr-old patient at 27 wk + 4 d of gestation who presented with rectal bleeding. Clinical history revealed a previous uterine posterior wall myomectomy. The patient received intensive diagnostic work-up including sonography and magnetic resonance imaging. Under the suspicion of a bleeding Meckel diverticulum, an emergency laparotomy was performed. Intraoperatively it was observed that the placental tissue infiltrated the small bowel intestine at the location of the previous myomectomy. The adjacent intestine and the infiltrating placenta were surgically removed. The placenta could be easily detached from the uterus, which is why no hysterectomy was performed. Retrospectively, no radiologic or clinical hints of PP or scar pregnancy were evident before the surgery. Moreover, the pathologic work-up carried out afterwards proved no histopathologic evidence for PP. Our case underlines several clinical and pathologic difficulties. First, invasive placenta disorders including infiltration of intestinal organs have to be considered even after minor surgical interventions such as myomectomy. Second, clinical presentation is extremely variable and sometimes misleading, depending on the localization and the type of invasion. Our case underlines the importance of histopathologic work-up for distinguishing between various placenta attachment disorders such as PP and scar pregnancy. Given the large overlap in clinical presentation, pathophysiology and definition, we propose that the current definitions for PP and scar pregnancy have to be carefully reevaluated and broadened.

Item Type:	Journal Article
Creators:	Creators Email ORCID ORCID Put Code Saleh, Mohamed M. UNSPECIFIED UNSPECIFIED UNSPECIFIED Mallmann, Michael R. UNSPECIFIED UNSPECIFIED UNSPECIFIED Essakly, Ahlem UNSPECIFIED UNSPECIFIED UNSPECIFIED Drebber, Uta UNSPECIFIED UNSPECIFIED UNSPECIFIED Kleinert, Robert UNSPECIFIED UNSPECIFIED UNSPECIFIED Kuetting, Fabian UNSPECIFIED UNSPECIFIED UNSPECIFIED Bratke, Grischa UNSPECIFIED orcid.org/0000-0002-5696-9828 UNSPECIFIED Mueller, Annette M. UNSPECIFIED UNSPECIFIED UNSPECIFIED
URN:	urn:nbn:de:hbz:38-661915
DOI:	10.1097/PGP.0000000000000778
Journal or Publication Title:	Int. J. Gynecol. Pathol.
Volume:	41
Number:	2
Page Range:	S. 151 - 157
Date:	2022
Publisher:	LIPPINCOTT WILLIAMS & WILKINS
Place of Publication:	PHILADELPHIA
ISSN:	1538-7151
Language:	English
Faculty:	Unspecified
Divisions:	Unspecified
Subjects:	no entry
Uncontrolled Keywords:	Keywords Language ACCRETA SPECTRUM DISORDER; PREGNANCY; PRECURSOR Multiple languages Obstetrics & Gynecology; Pathology Multiple languages
URI:	http://kups.ub.uni-koeln.de/id/eprint/66191