A New Problem Arising After the Cesarean, Cesarean Scar Defect (Isthmocele) a Case Report

Abstract

Background: Cesarean rates continue to increase all over the world. This has led to a particularly rapid increase in placenta-induced complications. A definition has emerged which is now called the new name istmosel, also called cesarean scar defect. Globally, the frequency is between 6.2% and 36%. Scar tissue in the old cesarean section causes problems such as menometrorrhagia, staining and infertility in patients. There are laparoscopic and hysteroscopic treatment approaches. Since there is a new terminology, there is no comprehensive publication in the literature to provide a general view on diagnosis and treatment. The primary treatment approach we offer in this case is laparoscopic surgery.Case Presentaion: A 37-year-old patient with gravida 2, parity 2, two previous cesarean section stories had complaints of continuing intermenstrual bleeding for 2 years. When the patient's examination and radiological evaluation is done, there was fluid accumulation in the old cesarean section.In the ultrasonographic examination; a dome-shaped fluid collection of about 2.3x1.4 cm was observed in the uterine lower segment anterior Wall. As a result, laparoscopic approach was decided for istmosel treatment. Conclusion:There is no consensus in the literature as to what type of suture or energy modality should be used to repair the isthmocele. In addition, there is no consensus on the superiority of double-layer suturing and superiority of the laparoscopic or hysteroscopic approach in cesarean scar repair.

Incidence of abnormal uterine bleeding with uterine scar defect after cesarean section (uterine niche) (Isthmocele)

“…It's possible that the functioning endometrium and inadequate scar contractility are the reasons for abnormal bleeding, and the defective drainage leads to the formation of blood clots in this defect, leading to inter-menstrual bleeding and pelvic pain [5].…”