Isthmocele: An important sequelae of caesarean section - report of three cases and mini review

Angel Yordanov, Strahil Strashilov, Stanislav Slavchev, Vasil Nanev, Denislava Ivanova, Momchil Ivanov


An isthmocele appears as a fluid-filled pouch-like defect in the anterior uterine wall at the site of a prior caesarean section, and ranges in prevalence from 19 per cent to 84 per cent, a direct relation to the increase in caesarean sections performed worldwide. It is the result of incomplete healing of the isthmic myometrium after a low transverse uterine incision performed for caesarean section. Although mostly asymptomatic, it may cause menstrual abnormalities, chronic pelvic pain, and secondary infertility. Scar tissue dehiscence, scar pregnancy, and abnormally adherent placenta are some of the obstetric complications associated with this defect. Diagnosis of the defects can be made with transvaginal ultrasound (TVUS), saline infused sonohysterogram (SIS), hysterosalpingogram, hysteroscopy, and magnetic resonance imaging (MRI). Surgical treatment of an isthmocele is still a controversial issue but it should be offered to symptomatic women or asymptomatic patient who desires future pregnancy. When surgery is the treatment choice, laparoscopy guided by hysteroscopy, or hysteroscopy alone are the best options depending on the isthmocele's characteristics and surgeon expertise.

We would like to present a mini-review of the topic with contribution of three cases.
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