P07.03: Deep lower abdominal pain caused by a hysterotomy defect in two post‐caesarean non‐pregnant women

Abstract

A myometrial groove is commonly seen for years after caesarean section (CS), by ultrasonographic examination. We present two women with myometrial defects after CS diagnosed by hysterosonography. Both women had had a single layer closure of the uterine incision at the CS and an uneventful postoperative recovery period. Both patients developed so severe deep abdominal pain in the first three months after their CS that a diagnostic laparotomy was performed to verify the defect in uterus seen on ultrasound. In both patients a defect was identified in the lower uterine segment. One woman insisted on having a hysterectomy and in the other case the hysterotomy defect was closed in two layers. At the two-month follow-up the women were doing well and their abdominal pains had totally disappeared. The woman, that not had a hysterectomy, had a hysterosonography performed and only a minimal uterine scar was seen. It has previously been reported that patients after CS have a risk of defective scars with a 1–4% risk of uterine rupture and dehiscence in the next pregnancy. Prior to rupture abdominal pain is often reported in the following pregnancy while the period between the pregnancies is without incident. It is generally recommended that pregnant women with previous CS should be regularly examined by ultrasound and that special attention is paid to the lower uterine segment. We believe that this post CS syndrome may be an under-diagnosed cause of abdominal pain and should be a differential diagnosis in the examination of young women with abdominal pain in the months after CS.