Isthmocele

Abstract

A 37-year-old woman, gravida 1, para1, presented with intermenstrual bleeding and secondary infertility. Her first pregnancy resulted in a Caesarean section for failure to progress in labour. Transvaginal ultrasound demonstrated a diverticulum in the anterior wall of the uterine isthmus, at the site of her previous Caesarean section scar (Figure 1). A combined hysteroscopic and laparoscopic approach was used to repair the defect because of the close proximity to the bladder. Because of hysteroscope angulation, the anterior uterine wall defect was visualized by turning the hysteroscope around (Figure 2).Figure 2View Large Image Figure ViewerDownload Hi-res image Download (PPT)Isthmocele can cause abnormal uterine bleeding and infertility. Functioning endometrium and impaired drainage from poor scar contractility can cause blood to accumulate in the reservoir-like pouch. This can result in intermenstrual bleeding and pelvic pain. Retained blood and debris may also interfere with sperm transport and embryo implantation.1.Fabres C. Aviles G. La Jara De C. Escalona J. Muñoz J.F. Mackenna A. The cesarean delivery scar pouch: clinical implications and diagnostic correlation between transvaginal sonography and hysteroscopy.J Ultrasound Med. 2003; 22 (quiz701–2): 695-700Crossref PubMed Scopus (138) Google Scholar, 2.Gubbini G. Centini G. Nascetti D. Marra E. Moncini I. Bruni L. et al.Surgical hysteroscopic treatment of cesarean-induced isthmocele in restoring fertility: prospective study. J Minim Invasive Gynecol 2011;18(2):234–7.J Obstet Gynaecol Can. 2013; 35: 779Abstract Full Text Full Text PDF PubMed Google Scholar Treatment with menstrual suppression or surgical repair can improve symptoms.Consent to publish these images was obtained from the patient. A 37-year-old woman, gravida 1, para1, presented with intermenstrual bleeding and secondary infertility. Her first pregnancy resulted in a Caesarean section for failure to progress in labour. Transvaginal ultrasound demonstrated a diverticulum in the anterior wall of the uterine isthmus, at the site of her previous Caesarean section scar (Figure 1). A combined hysteroscopic and laparoscopic approach was used to repair the defect because of the close proximity to the bladder. Because of hysteroscope angulation, the anterior uterine wall defect was visualized by turning the hysteroscope around (Figure 2). Isthmocele can cause abnormal uterine bleeding and infertility. Functioning endometrium and impaired drainage from poor scar contractility can cause blood to accumulate in the reservoir-like pouch. This can result in intermenstrual bleeding and pelvic pain. Retained blood and debris may also interfere with sperm transport and embryo implantation.1.Fabres C. Aviles G. La Jara De C. Escalona J. Muñoz J.F. Mackenna A. The cesarean delivery scar pouch: clinical implications and diagnostic correlation between transvaginal sonography and hysteroscopy.J Ultrasound Med. 2003; 22 (quiz701–2): 695-700Crossref PubMed Scopus (138) Google Scholar, 2.Gubbini G. Centini G. Nascetti D. Marra E. Moncini I. Bruni L. et al.Surgical hysteroscopic treatment of cesarean-induced isthmocele in restoring fertility: prospective study. J Minim Invasive Gynecol 2011;18(2):234–7.J Obstet Gynaecol Can. 2013; 35: 779Abstract Full Text Full Text PDF PubMed Google Scholar Treatment with menstrual suppression or surgical repair can improve symptoms. Consent to publish these images was obtained from the patient.