title: Exchange of intraoperative balloon occlusion of the internal iliac artery for the common iliac artery during cesarean hysterectomy in a patient with placenta percreta.
abstract: METHODS
  Female, 36 FINAL DIAGNOSIS: Pregnancy - placenta increta Symptoms: -
  
  
  METHODS
  - Clinical Procedure: Cesarean hysterectomy Specialty: Obstetrics and Gynecology.
  
  
  OBJECTIVE
  Unusual clinical course.
  
  
  BACKGROUND
  The 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.
  
  
  METHODS
  We 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.
  
  
  CONCLUSIONS
  CIABO 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.
authors.affiliation: Department of Obstetrics and Gynecology, Otsu-Red Cross Hospital, Otsu, Shiga, Japan.
authors.forename: Kenji
authors.initials: K
authors.lastname: Hishikawa
authors.forename: Masafumi
authors.initials: M
authors.lastname: Koshiyama
authors.forename: Masashi
authors.initials: M
authors.lastname: Ueda
authors.forename: Ayaka
authors.initials: A
authors.lastname: Yamaguchi
authors.forename: Shingo
authors.initials: S
authors.lastname: Ukita
authors.forename: Haruhiko
authors.initials: H
authors.lastname: Yagi
authors.forename: Kazuyo
authors.initials: K
authors.lastname: Kakui
keywords: balloon occlusion; cesarean hysterectomy; common iliac artery; internal iliac artery; placenta percreta