• Kenji Hishikawa, Masafumi Koshiyama, Masashi Ueda, Ayaka Yamaguchi, Shingo Ukita, Haruhiko Yagi, and Kazuyo Kakui.
• Department of Obstetrics and Gynecology, Otsu-Red Cross Hospital, Otsu, Shiga, Japan.
• Am J Case Rep. 2013 Jan 1; 14: 409-11.

PatientFemale, 36 FINAL DIAGNOSIS: Pregnancy - placenta increta Symptoms: -Medication- Clinical Procedure: Cesarean hysterectomy Specialty: Obstetrics and Gynecology.ObjectiveUnusual clinical course.BackgroundThe generally accepted treatment for placenta percreta is cesarean hysterectomy without attempts to detach the placenta. Preoperative internal iliac artery balloon occlusion (IIABO) has been widely performed to minimize blood loss during cesarean hysterectomy for an abnormal attachment of the placenta. Our case is the first reported case of common iliac artery balloon occlusion (CIABO) being more effective than IIABO for reducing blood loss during a cesarean hysterectomy in the same patient.Case ReportWe performed cesarean hysterectomy with IIABO in a 36-year-old Japanese female who had placenta percreta. However, there was still a large amount of blood loss. We immediately changed the balloon from the internal iliac artery to the common iliac artery, which visibly reduced the amount of blood loss. We finally achieved cesarean hysterectomy.ConclusionsCIABO was found to be more effective than IIABO for reducing blood loss during cesarean hysterectomy. Failure of IIABO can be explained by the presence of extensive anastomoses in the pelvic vasculature.

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