{"paper_id":"3d0b7280-0f89-49fa-b886-d272a77ea090","body_text":"Abstract\nBackground\nCesarean scar defects or isthmoceles are increasingly detected in the recent times due to the rise in cesarean rates worldwide. They may develop due to poor healing at myometrial site. The pouch accumulates the menstrual blood and very rarely in long standing cases develops endometriomas in the wall.\nCase presentation\nA 30-year-old woman, para 1 living 1 with previous cesarean delivery 9 years back, presented to us with secondary infertility, chronic pelvic pain and post menstrual bleeding. A routine Transvaginal ultrasonography (TVS) showed a large fluid filled outpouching adjoining the uterine scar line, in communication with endometrial cavity. T2 weighted magnetic resonance Imaging (MRI) showed a huge isthmocele arising from the scar defect at lower uterine segment measuring 96 x 60 x52 mm with multiple endometrial rests in the wall showing shading and hypo intensity. The ishtmocele was laparoscopically excised and defect closed in two layers with hysteroscopic transillumination guidance. On hisptopathlogical examination, the lining of isthmocele had endocervical epithelium with thick fibromuscular tissue and focal areas of endometriosis. Postoperative period was uneventful and patient was discharged on third postoperative day. The patient was relieved of her pain abdomen and postmenstrual bleeding at 6 months follow-up.\nConclusion\nLaparoscopic approach is the preferred surgical technique in huge isthmoceles. Endometrioma develop within the wall of the pseudosac during natural course of the disease in longstanding ishthmoceles. Meticulous closure of uterine incision during cesarean section making sure that edges are taken properly into the stiches along with proper antibiotic coverage in cases with premature rupture of membranes (PROM) can prevent occurrence of isthmocele. Early diagnosis and surgical repair can prevent the progressive disease and Cesarean scar defect Syndrome.\nAbbreviations\n- CSS:\n-\nCaesarean scar syndrome\n- TVS:\n-\nTransvaginal ultrasonography\n- MRI:\n-\nMagnetic resonance imaging\n- PROM:\n-\nPremature rupture of membranes\n- SHG:\n-\nSonohysterography\n- RM:\n-\nResidual myometrium\nReferences\nNaji O, Abdallah Y, Bij De Vaate AJ, Smith A, Pexsters A, Stalder C, McIndoe A, Ghaem-Maghami S, Lees C, Brolmann HA, Huirne JA, Timmerman D, Bourne T. Standardized approach for imaging and measuring Cesarean section scars using ultrasonography. Ultrasound Obstet Gynecol. 2012;39:252–9. https://doi.org/10.1002/uog.10077.\nRupa1 R, Suchana Kushvaha1, Venkatesh K. Uterine isthmocele—A frequently overlooked complication of cesarean sections. Indian J Radiol Imaging 31(3/2021©2021)\nVervoort A, Vissers J, Hehenkamp W, Brölmann H, Huirne J. The effect of laparoscopic resection of large niches in the uterine caesarean scar on symptoms, ultrasound findings and quality of life: a prospective cohort study. BJOG. 2018;125(3):317–25.\nStavros Karampelas, Georges Salem Wehbe, Laurent de Landsheere, Dominique A. Badr, Linda Tebache and Michelle Nisolle. Laparoscopic isthmocele repair: efficacy and benefits before and after subsequent cesarean section. J Clin Med. 2021;10, 5785. https://doi.org/10.3390/jcm10245785\nFunding\nThere were no funds or grants involved.\nAuthor information\nAuthors and Affiliations\nContributions\nAll authors contributed to the patient management and follow-up.\nCorresponding author\nEthics declarations\nConflict of interest\nNone of the authors have any potential conflict of interest.\nEthical Statement\nInformed consent was obtained from the patient for presenting her data for publication. All parts of Declaration of Helsinki have been applied.\nInformed Consent\nThe patient involved in this was appropriately consented for this publication using institution’s policy for publication.\nAdditional information\nPublisher's Note\nSpringer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.\nAkkamahadevi C. Hiremath, MBBS, M.D. (Obstetrics & Gynaecology) is a Senior Consultant and Head of the Department of Obstetrics & Gynaecology; Anuja Doolam, MBBS, DNB (Obstetrics & Gynaecology) is a Junior Consultant; K. S. Shivakumar, MBBS, MS, MCh (Urology) is a Senior Consultant; Dimpi Sinha, MBBS, M.D.(Radiology) is a Senior Consultant; N. S. Nayana, MBBS, M.D.(OncoPathology) is a Fellow; Geetanjali Tulapurkar, MBBS, M.D. (Anaesthesiology) is Senior Consultant.\nRights and permissions\nAbout this article\nCite this article\nHiremath, A.C., Doolam, A., Shivakumar, K.S. et al. Post-Caesarean Huge Isthmocele with Multiple Endometriomas and Cervical Stenosis: Laparoscopic Excision and Repair. J Obstet Gynecol India 75, 75–78 (2025). https://doi.org/10.1007/s13224-023-01877-2\nReceived:\nAccepted:\nPublished:\nVersion of record:\nIssue date:\nDOI: https://doi.org/10.1007/s13224-023-01877-2","source_license":"CC0","license_restricted":false}