Successful treatment of atypical cesarean scar defect using endoscopic surgery

Hirotaka Masuda,Mamoru Tanaka,Tetsuo Maruyama,Kenji Sato,Suguru Sato,Hiroshi Uchida

doi:10.1186/s12884-015-0730-x

Abstract

BackgroundCesarean scar syndrome results from a postoperative defect of the uterine isthmus, also known as an isthmocele. Patients present with gynecological symptoms, such as abnormal genital bleeding or infertility, after cesarean delivery. Although the cesarean rate is increasing worldwide, this syndrome is not widely known.Case presentationA 43-year-old G2P1 Japanese woman with atypical cesarean scar syndrome had a 3-year history of secondary infertility and postmenstrual brown discharge. Laparoscopic and hysteroscopic exploration revealed a cesarean scar defect connected to a small cavity in the myometrium: this was not an endometrial cavity or a uterine diverticulum. After endoscopic excision of the cavity, the brown discharge resolved, and the patient achieved ongoing pregnancy on her third attempt at intrauterine insemination.ConclusionConsensus is still lacking regarding the diagnosis and treatment of cesarean scar defect. However, the gynecologists should be aware that cesarean scar syndrome can have scar defects forming cavities of unusual shapes and features. Surgical correction of these defects will often improve postmenstrual bleeding and subfertility in these cases.

Highlights

Cesarean scar syndrome results from a postoperative defect of the uterine isthmus, known as an isthmocele
Scar defects at the isthmus uteri, known as cesarean scar defects or isthmoceles, are often found after cesarean delivery [1]
Other problems associated with cesarean scar defect are a higher risk of complications during subsequent pregnancy [6], such as dehiscence, placenta previa or accreta [7] and cesarean scar ectopic pregnancy [8], and difficulty with gynecologic procedures like uterine evacuation, hysteroscopy, and intrauterine-device insertion [9]

Summary

Conclusion

Consensus is still lacking regarding the diagnosis and treatment of cesarean scar defect. The gynecologists should be aware that cesarean scar syndrome can have scar defects forming cavities of unusual shapes and features. Surgical correction of these defects will often improve postmenstrual bleeding and subfertility in these cases

Background

Findings

Conclusions