Uterine Diverticulum Research Articles

The Use of Foley Catheters in Hysteroscopy Combined With Laparoscopy for the Treatment of Post-Cesarean Section Uterine Diverticulum

The Use of Foley Catheters in Hysteroscopy Combined With Laparoscopy for the Treatment of Post-Cesarean Section Uterine Diverticulum

Diagnostic Correlation between Saline Infused Sono Hysterography and Three-Dimensional Transvaginal Ultrasound in the Assessment of Cesarean Section Scar Defect. A Study of a Diagnostic Test Accuracy

Abstract Background The evolution of Sono hysterography over the past years has contributed significantly to the assessment of uterine cavity. Saline infused Sono hysterography (SIS) may be recommended as an alternative to Diagnostic Hysteroscopy for the assessment of the uterine cavity and uterine scar in women with previous Cesarean Section. Three-dimensional (3D) ultrasonography that enhances visualization of the lower uterine segment (LUS), myometrial thickness and the size of uterine diverticulum is a more recent tool used to diagnose post- cesarean section uterine diverticulum. Objective To compare accuracy of three-dimensional transvaginal ultrasound versus saline infused sonography for assessing the characteristics, frequency of caesarean scar defects in symptomatic patients with a history of cesarean section. Patients and Methods This study was conducted with 72 women. patients were recruited from the ultrasound unit underwent both three-dimensional transvaginal ultrasound and saline infused son hysterography. This study, conforming to the declaration of Helsinki, was approved by the ethical committee of Obstetrics and Gynecology department, Ain Shams University, ethical committee number FMASU M D 52 \2021. Results 3D transvaginal ultrasound and Sono hysterography showed almost good agreement regarding prevalence of niche with kappa (κ) 0.780 with p-value (p < 0.001). Both imaging modalities show statistically significant higher mean value of volume in SIS was 591.67±271.05 comparing to 3D TVUS was 444.36±219.42, with p-value (p = 0.004). Conclusion There is a substantial agreement between 3D TVUS and SIS in evaluating various niche characteristics, encompassing depth, length, width, volume, AMT and RMT. The data strongly supports the advantages of 3D TVUS over SIS for assessing Cesarean scar defects, commonly known as “Niche.” These benefits encompass cost-effectiveness, improved time efficiency, enhanced patient tolerability, and heightened patient satisfaction associated with the 3D TVUS procedure.

Forceps-assisted delivery leads to the formation of a giant uterine isthmus diverticulum: A case report

The formation of uterine diverticula following forceps-assisted delivery is a rare complication characterized by irregular and prolonged postpartum menstruation. While ultrasound and MRI can assist in diagnosis, the identification of this condition often suffers from delayed recognition due to an absence of cesarean section history. Case Report: We present a case involving a 31-year-old woman who developed a uterine diverticulum as a result of forceps delivery and was misdiagnosed for four years. Conclusions: This case report highlights an uncommon complication associated with forceps-assisted delivery—uterine diverticula—and proposes strategies for the early identification and prevention of such conditions following these types of deliveries.

Hysteroscopic management of uterine diverticulum after myomectomy: a case report

BackgroundA uterine diverticulum is defined as the presence of a niche within the inner contour of the uterine myometrial wall. Although secondary uterine diverticula can occur after hysterotomy such as cesarean section, reports of diverticula after myomectomy are extremely rare.Case presentationA 45-year-old nulliparous woman undergoing infertility treatment was referred to our hospital because of abnormal postmenstrual bleeding after myomectomy. Transvaginal sonography and magnetic resonance imaging revealed a diverticulum in the isthmus. Fat-saturated T1 image showed a blood reservoir in the diverticulum. Hysteroscopic surgery was performed to remove the lowed edge of the defect and coagulate the hypervascularized area. Two months after surgery, the abnormal postmenstrual bleeding and chronic endometritis improved.Discussion and conclusionsThis report highlights the similarities of the patient’s diverticulum to cesarean scar defects in terms of symptoms and pathophysiology. First, this patient developed a diverticulum with hypervascularity after myomectomy and persistent abnormal bleeding. Second, after hysteroscopic surgery, the symptoms of irregular bleeding disappeared. Third, endometrial glands were identified within the resected scar tissue. Fourth, preoperatively identified CD138-positive cells in endometrial tissue spontaneously disappeared after hysteroscopic resection. To the best of our knowledge, this is the first report of symptomatic improvement following hysteroscopic surgery in a patient with an iatrogenic uterine diverticulum with persistent irregular bleeding after myomectomy.

Successful surgical treatment of postmyomectomy uterine diverticulum: a case report

BackgroundUterine diverticulum is classified into congenital and acquired types. The acquired type is caused by caesarean scar syndrome, which occurs after caesarean section. There are no detailed reports on diverticulum after enucleation of uterine fibroids. Most cases are treated with hysteroscopy or laparoscopy, but a management consensus is lacking. We treated a patient with a uterine diverticulum that had formed after uterine fibroid enucleation by combining hysteroscopic and laparoscopic treatments.Case presentationThe patient was a 37-year-old Japanese woman, G1P0. A previous doctor had performed abdominal uterine myomectomy for a pedunculated subserosal uterine fibroid on the right side of the posterior wall of the uterus near the internal cervical os. Menstruation resumed postoperatively, but a small amount of dark-red bleeding persisted. MRI two months after the myomectomy revealed a diverticulum-like structure 3 cm in diameter, communicating with the uterine lumen, on the right side of the posterior wall of the uterus. Under suspicion of uterine diverticulum after uterine fibroid enucleation, the patient sought treatment at our hospital approximately four months after the myomectomy. Through a flexible hysteroscope, a 5-mm-diameter fistula was observed in the posterior wall of the uterus, and a contrast-enhanced pocket, measuring approximately 3 cm, was located behind it. Uterine diverticulum following enucleation of a uterine fibroid was diagnosed, and surgery was thus deemed necessary. The portion entering the fistula on the internal cervical os side was resected employing a hysteroscope. Intra-abdominal findings included a 4-cm mass lesion on the posterior wall on the right side of the uterus. The mass was opened, and the cyst capsule was removed. A 5-mm fistula was detected and closed with sutures. Resuturing was not performed after dissection of the right round ligament due to tension. The postoperative course has been good to date, with no recurrence.ConclusionUterine diverticula after myomectomy may be treated with a combined laparoscopic and hysteroscopic approach, similar to caesarean scar syndrome.

Outcomes of Laparoscopic Cesarean Scar Defect Repair: Retrospective and Observational Study.

Cesarean scar defect, also known as niche, isthmocele, uteroperitoneal fistula and uterine diverticulum, is a known complication after cesarean delivery. Due to the rising cesarean delivery rates, niche has become more common and can present as irregular bleeding, pelvic pain, infertility, cesarean scar pregnancy and uterine rupture. Treatments for symptomatic cesarean scar defect vary and include hormonal therapy, hysteroscopic resection, vaginal or laparoscopic repair, and hysterectomy. We report on the safety and efficacy of our method of repairing cesarean scar defects in 27 patients without adverse outcomes: two-layer repair where the suture does not enter the uterine cavity. Our method of laparoscopic niche repair improves symptoms in nearly 77% of patients, restores fertility in 73% of patients, and decreases the time to conception.

A new tapeworm from Compsophis infralineatus (Pseudoxyrhophiidae), an endemic snake of Madagascar: Scratching the surface of undiscovered reptilian parasite diversity.

A new species of proteocephalid cestodes, provisionally assigned to the polyphyletic genus Ophiotaenia La Rue, 1911 (Cestoda: Proteocephalidae), is described from Compsophis infralineatus (Günther) (Serpentes: Pseudoxyrhophiidae) endemic to Madagascar. Ophiotaenia oreae n. sp. differs from all African and Asian species of Ophiotaenia by possessing more uterine diverticula (68-82 on one side). It is also characterised by the absence of an apical organ, the relative sizes of the cirrus-sac and ovary, the almost equatorial position of the gonopore, the diameter of the embryophore, and other biometric characteristics. Phylogenetic relationships of the new species indicate its relatedness to Indomalayan and Australasian proteocephalids from reptiles. Ophiotaenia oreae n. sp. formed a well-supported clade composed of species of Australophiotaenia de Chambrier, Beveridge and Scholz, 2018 from Australian snakes, Macrobothriotaenia ficta (Meggitt, 1931) from Xenopeltis unicolor Reinwardt in Boie from Vietnam, Ophiotaenia sp. from Trimeresurus flavomaculatus (Gray) from the Philippines, and Ophiotaenia bungari de Chambrier, Binh and Scholz, 2012 from Bungarus fasciatus (Schneider) from Vietnam. The only proteocephalid from Madagascan snakes sequenced so far, Ophiotaenia lapata Rambeloson, Ranaivoson and de Chambrier, 2012 from Madagascarophis colubrinus (Schlegel), does not form a monophyletic group with the new species. The actual species diversity of reptilian cestodes in Madagascar is undoubtedly underestimated. Because of the assumed strict (oioxenous) host specificity of reptilian proteocephalids and rich fauna of snakes occurring in Madagascar, it is plausible to expect the existence of dozens new species of proteocephalids on this island.

Prediction of Scar Myometrium Thickness and Previous Cesarean Scar Defect Using the Three-Dimensional Vaginal Ultrasound.

This research aimed to explore the related factors of scar myometrial thickness and scar diverticulum formation and then predict the occurrence of uterine diverticula. 140 patients with cesarean section were selected as the research objects. According to the three-dimensional (3D) vaginal ultrasound echo and the diagnostic criteria of uterine diverticulum, the research objects were divided into a diverticulum group and a control group, with 70 cases in each group. Data such as age, number of cesarean sections, endometrial thickness, uterine position, and diverticulum size was collected, and their relationship with uterine diverticulum was compared and analyzed. The results showed that there were significant differences in menstrual days, cesarean section times, and uterine position between the two groups (P < 0.05). The height (9.02 ± 2.97), width (14.02 ± 3.08), and depth (5.14 ± 1.23) of the posterior uterine diverticula in the scar diverticulum group were all greater than the anterior uterine height (6.69 ± 1.36), the width (10.69 ± 2.15), and the depth (3.86 ± 0.69), respectively. The residual myometrium thickness in posterior position of the uterus (2.98 ± 0.75) was < anterior position of uterus (3.43 ± 0.47), and the difference was statistically significant (P < 0.05). Multivariate analysis showed that the frequency of cesarean section (1 time, 2 times), uterine position, and abnormal menstruation were independent risk factors in the scar diverticulum group (P < 0.05). In conclusion, menstrual abnormalities, the number of cesarean sections (1 time or twice), and the position of the uterus are independent risk factors for the formation of uterine scar diverticula. The deeper the diverticula, the more likely to have menstrual abnormalities, the more prone to diverticulum in patients with posterior uterus, and the deeper the diverticula in patients with 2 dissections.

Determinants of uterine scarring

Despite current recommendations to encourage vaginal birth, the rate of cesarean sections has increased significantly in recent years, leading to an increase in the rate of uterine scar defects. The association between these defects and multiple maternal comorbidities motivates their study for prevention. Using various online library search engines such as PubMed, Medscape, UpToDate, Cochrane, we selected studies on the factors that cause deficient uterine scarring. In literature, it has various names, such as: isthmocele, niche, uterine scar dehiscence or uterine diverticulum. For this paper, 11 scientific articles were selected, choosing only the factors for which a positive statistical link was observed, meaning the increase of the risk of uterine scar defect. Currently, there is no unanimity on the factors that influence the quality of uterine scarring, for many of the factors analyzed there are also other contradictory studies.

Effect of Laparoscopic Combined Repair on Uterine Incision Diverticulum after Cesarean Section

Effect of Laparoscopic Combined Repair on Uterine Incision Diverticulum after Cesarean Section

Enlarged uterine fibroid forming uterine diverticulum during pregnancy: a case report

BackgroundAlthough uterine fibroids are a common gynecologic neoplasm, uterine diverticulum accompanied by a uterine fibroid is unique. In addition, pregnancy complicated with uterine diverticulum is extremely rare. We experienced a case of a uterine fibroid that was associated with a uterine diverticulum that enlarged during pregnancy and puerperium.Case presentationA 25-year-old nulligravida woman had an abnormal uterine cavity surrounded by myomatous mass. After natural conception, the mass and pouch had enlarged during pregnancy. Six months after elective cesarean delivery, she underwent laparotomy because of abdominal pain caused by the myomatous mass and the fluid inside. The tumor was connected to the midline of the posterior wall of the normal uterus. The resected tumor was pathologically diagnosed as leiomyoma and diverticulum.ConclusionsPregnancy can stimulate uterine fibroids to form uterine diverticula. Resection of the diverticulum and fibroid is a useful option for symptomatic patients with desired future fertility.

Obstetric and Gynecologic Outcomes after the Transvaginal Repair of Cesarean Scar Defect in a Series of 183 Women

To analyze retrospectively the effect of hysteroscopy combined with transvaginal repair on the cesarean section diverticulum (CSD) and explore the clinical significance of this procedure. Retrospective study. University-affiliated hospital and a gynecology hospital. A total of 183 patients with scar diverticulum after cesarean section were recruited from the Southern Medical University Affiliated Maternal & Child Health Hospital of Foshan and Shenzhen In Vitro Fertilization Gynecological Hospital. In this study, we reported a surgical method for repairing uterine scar through uterine therapy and explored its clinical efficacy and pregnancy outcome. The time of operation, volume of bleeding, and duration of hospitalization were recorded. The size of the scar diverticulum and the remaining myometrium were examined by B-mode ultrasonography before and after the operation. The length of the menstrual cycle and pelvic pain were recorded during follow-up to check the recovery of patients after surgery. The pregnancy of patients with pregnancy needs was recorded to check the pregnancy outcome. All 183 patients successfully completed the repair of the transvaginal uterus scar diverticulum with the help of a hysteroscopy examination. The mean (± standard deviation) operation time was 58.61 ± 18.56 minutes. The mean blood loss was 36.97 ± 22.32 mL. The mean hospital stay was 6.08 ± 1.89 days. In 57.14% of patients, the CSD completely disappeared, whereas the volume of CSD shrank by at least 50% in 88.95% of patients. The mean menstrual period of patients after surgery was 7.72 ± 2.68 days, which was significantly shorter than that recorded preoperatively (13.45 ± 3.69 days) (t = 19.62, p = .00). The pelvic pain disappeared in 81.08% of the patients. The mean postoperative thickness of the remaining muscular layer was 5.30 ± 1.27-mm, which was significantly higher than the preoperative value of 2.25 ± 0.92-mm (t = 28.21, p = .00). The mean postoperative thickness of the remaining muscular layer of patients with improved menstrual cycle was 5.40 ± 1.27-mm, which was significantly higher than the thickness of 4.88 ± 1.11-mm in patients without improved menstrual cycle (t = 2.31, p = .025). A total of 124 patients attempted to become pregnant, 83 of whom were successful. The pregnancy rate was as high as 66.95%, which included 2 scar pregnancies, 4 ectopic pregnancies, and 87 intrauterine pregnancies. No uterine rupture occurred. The transvaginal repair of the uterine diverticulum improved the symptoms and probability of a successful pregnancy effectively. This process is a surgical procedure to increase the thickness of the residual uterine muscle wall effectively.

Tapeworms (Cestoda) of Ictalurid Catfishes (Siluriformes) in North America: Redescription of Type Species of Two Genera and Proposal of Essexiellinae n. Subfam.

Ictalurid catfishes (Siluriformes) in North America harbor proteocephalid tapeworms of the subfamily Corallobothriinae. Type species of 2 of 3 genera of these tapeworms from ictalurids are redescribed, based on museum and newly collected material. Essexiella fimbriata (Essex, 1928) is typified mainly by a wide, umbrella-shaped scolex with a metascolex formed by numerous folds of tissue, anteriorly directed suckers without sphincters, vitellarium bent inwards posteriorly, "flower-shaped" uterus (with anterior, lateral, and posterior diverticula), and a conspicuously pre-equatorial genital atrium. Verified host records of this cestode are only from 3 species of Ictalurus Rafinesque, 1820. Megathylacoides giganteum (Essex, 1928), which seems to be specific to the channel catfish (Ictalurus punctatus), possesses a globular scolex, with a weakly developed metascolex formed by tissue folds posterior to the suckers, anterolaterally directed suckers with large semilunar sphincters, proglottids that are widest at the level of the genital atrium at the anterior third of the proglottid, and uterine diverticula that do not reach the vitelline follicles laterally. A new subfamily, Essexiellinae Scholz and Barčák, is proposed to accommodate species of EssexiellaScholz, de Chambrier, Mariaux and Kuchta, 2011 (type genus), MegathylacoidesJones, Kerley and Sneed, 1956, and CorallotaeniaFreze, 1965 from ictalurid catfishes in the Nearctic Region. These tapeworms possess a metascolex, medullary genital organs, uterus lined with numerous chromophilic cells, pre-equatorial genital atrium, and uterine development of type 2. The new subfamily was monophyletic in all molecular phylogenetic analyses, being most closely related to 3 Neotropical proteocephalids from the redtail catfish, Phractocephalus hemioliopterus (Bloch and Schneider, 1801), but distant from all remaining proteocephalid tapeworms from freshwater fishes in North America.

Association of Menstrual Extension and Surgery Effectiveness with Ultrasound Parameters of Cesarean Section Scar Diverticulum in Patients Undergoing Transvaginal Uterine Diverticulum Repair.

The association of residual myometrium thickness (RMT) and scar defect depth (D) with menstrual abnormalities and the effectiveness of vaginal repair remain to be determined in patients with cesarean section scar diverticulum (CSD). To assess the value of ultrasound to predict vaginal repair effectiveness. This was a retrospective study of patients with CSD treated with vaginal repair between 01/2014 and 02/2016 at Shanghai First Maternity and Infant Hospital (Tongji University). Transvaginal ultrasound was performed before and 3 months after surgical repair. RMT, D, scar defect length (L), and scar defect width (W) were measured. Width (W), D, and L increased along the duration of menstrual period (P < 0.05). When the menstrual extension time was ≥15 days, RMT/D and RMT/(RMT + D) were smaller than in patients with period <15 days (P < 0.05). L was the most positively correlated ultrasonic parameter with menstrual prolongation (r = 0.492). RMT/D and RMT/(RMT + D) were negatively correlated with prolonged menstruation (r = ‐0.304 and -0.305, respectively). RMT/D and RMT/(RMT + D) were associated with the disappearance of CSD after vaginal repair (P < 0.05). The cutoff value of RMT/(RMT + D) was 0.496, with sensitivity of 53.0% and specificity of 61.4%. L of CSD is closely correlated with menstrual extension but has no relationship with the effectiveness of surgery. RMT/(RMT + D) is correlated with menstrual extension time ≥15 days and the effectiveness of vaginal repair.

Niche After Cesarean Section

A uterine niche, also calld cesarean scar defect, or cesarean scar dehiscence, uterine diverticulum, uterine sacculation or isthmocele. It is a man made pouchlike defect of the anterior uterine isthmus occurs at the site of a prior cesarean section. Its occurrence has been increased in the last years secondary to the increased incidence of cesarean section. Many patients with isthmocele are asymptomatic. The most frequent complaint relates to intermittent postmenstrual bleeding as the isthmocele functions as a reservoir collecting blood during menstruation, with irregular menses that can run for 2 to 12 days. Various sources have described isthmocele as a case of infertility, pain and dysmenorrhea. An isthmocele is typically diagnosed on transvaginal sonography, hysterosalpinography and hysteroscopy. Magnetic resonance tomography is useful to measure the thickness of the lower uterine segment, the profundity of the isthmocele. The treatment of isthmocele includes laparotomy, laparoscopy, hysteroscopy, vaginal repair, and several combined techniques with no statistically superior outcome noted in the literature. In that respect is no gold standard treatment for isthmocele.

Molecular and morphological characterization of Paurodontella composticola n. sp. (Nematoda: Hexatylina, Sphaerulariidae) from Iran.

A new species of the genus Paurodontella, P. composticola n. sp., collected from Nazar Abad City, Alborz Province, Iran, is described and illustrated. The new species has a body length of 803–1053 μm (females n = 10) and 620 and 739 μm (males n = 2). The cuticle is weakly annulated with four lateral lines. Cephalic region is annulated and continuous with body contour. The stylet is 8.0 to 9.0 μm long with asymmetrical knobs. Esophageal basal bulb is present with a small posterior extension projecting into the intestine. Excretory pore is situated at the level of esophageal basal bulb region. Post-uterine sac is 5 to 8 μm long and uterus is without diverticulum. Tails of both sexes are similar, short and sub-cylindrical. Males have 24 to 25 μm long bursa leptoderan and spicules 24 or 25 µm long. A non-branching oviduct is present to form a uterine diverticulum; the new species is closely related to five known species of the genus, namely P. asymmetrica, P. balochistanica, P. densa, P. iranica and P. niger. It most closely resembles P. iranica, but differs from it morphologically by a shorter stem-like extension projecting into lumen of intestine and male with sub-cylindrical tail vs conoid. In addition to morphological comparisons, the molecular phylogenetic analyses based on 733 bp of the partial sequence of 28S D2/D3 expansion segments of the large subunit rDNA gene (LSU) revealed this as a new species.

Hysteroscopy combined with laparoscopy in treatment of patients with post-cesarean section uterine diverticulum.

IntroductionPost-cesarean section uterine diverticulum (PCSUD) is a recess in the lower uterine segment of the cesarean section incision that protrudes to the serosa due to healing defects. With the abolition of the one-child policy, allowing couples to have two children in the past year in China, more and more couples plan to give birth to a second baby. However, with the significant increase in the cesarean section rate in the past two decades in China, the incidence of PCSUD also obviously increased.AimTo evaluate the clinical efficacy and safety of hysteroscopy combined with laparoscopy in treatment of patients with PCSUD.Material and methodsFifty-two cases of patients with post-cesarean section uterine diverticulum (PCSUD) who suffered from conservative treatment failure in the Beijing Obstetrics and Gynecology Hospital (affiliated to Beijing Capital Medical University) between January 2012 and June 2017 were retrospectively analyzed in this study. Patients with reproductive requirements were treated with hysteroscopy combined with laparoscopy surgery (experimental group, n = 31); those without reproductive requirements were treated with hysteroscopic surgery (control group, n = 21). The operation time, intraoperative blood loss, hospital stay period, clinical efficacy and recurrence rate of the two groups were compared.ResultsAll the patients successfully completed the operation procedure in both experimental and control groups. The operation time, intraoperative blood loss and post-operative hospital stay in the experimental group were significantly higher than those of the control group (p < 0.05). There was no significant difference in clinical efficacy or recurrence between the two groups (p > 0.05). Six months after the operation, the uterus muscularis thickness was 4.2 ±1.9 mm and 9.8 ±6.2 mm for control and experimental groups respectively, which indicates that the muscularis thickness in the experimental group was significantly greater than that of the control group (p < 0.05).ConclusionsHysteroscopy combined with laparoscopy was safe with satisfactory results in treatment of patients with PCSUD.

Paurodontella iranicasp. nov. of Sphaerulariidae (Nematoda) from North West Iran

Abstract. Paurodontella iranica sp. nov. is described and illustrated from West Azerbayjan province, Northwestern Iran. The new species was recovered from a soil sample from rhizosphere of Rosa persica Michx. ex Juss. It is characterized by body length of 681–1024 µm in females, lateral fields with four incisures; outer incisures crenate and inner smooth, stylet 8–9 µm long with asymmetrical knobs, excretory pore 100–140 µm far from anterior end, hemizonid 8–10 µm anterior to excretory pore, basal bulb with long stem-like extension projecting into the intestine, post-uterine sac rudimentary, tail short and sub-cylindrical. Mail tail conical with subterminal bursa. By having oviduct not branching to form a uterine diverticulum, the new species comes close to four known species of the genus namely P. densa (Thorne, 1941), P. balochistanica Handoo, Iqbal, Kazi et Fayyaz, 2010, P. niger (Thorne, 1941), P. asymmetrica (Tikyani et Khera, 1968). It resembles most closely P. balochistanica but differs from it by ...

Efficacy of Combined Laparoscopic and Hysteroscopic Repair of Post-Cesarean Section Uterine Diverticulum: A Retrospective Analysis.

Background. Diverticulum, one of the long-term sequelae of cesarean section, can cause abnormal uterine bleeding and increase the risk of uterine scar rupture. In this study, we aimed to evaluate the efficacy of combined laparoscopic and hysteroscopic repair, a newly occurring method, treating post-cesarean section uterine scar diverticulum. Methods. Data relating to 40 patients with post-cesarean section uterine diverticulum who underwent combined laparoscopic and hysteroscopic repair were retrospectively analyzed. Preoperative clinical manifestations, size of uterine defects, thickness of the lower uterine segment (LUS), and duration of menstruation were compared with follow-up findings at 1, 3, and 6 months after surgery. Results. The average preoperative length and width of uterine diverticula and thickness of the lower uterine segment were recorded and analyzed. The average durations of menstruations at 1, 3, and 6 months after surgery were significantly shorter than the preoperative one (p < 0.05), respectively. At 6 months after surgery, the overall success improvement rate of surgery was 90% (36/40). Three patients (3/40 = 7.5%) developed partial improvement, and 1/40 (2.5%) was lost to follow-up. Conclusions. Our findings showed that combined treatment with laparoscopy and hysteroscopy was an effective method for the repair of post-cesarean section uterine diverticulum.

Successful treatment of atypical cesarean scar defect using endoscopic surgery

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.