Endometriosis at the level of uterine isthmocele: Case report

An isthmocele is a reservoir-type defect in the fornix of the cul-de-sac in the anterior wall of the isthmus at the site of the previous cesarean scar. It’s appearance is related to the accumulation of menstrual blood flow through the cervix and with the presence of fibrotic tissue and pelvic pain. We present the case of a 33-year-old patient, with a history of a cesarean section 2 years ago, who presents for preconceptional counseling complaining of abnormal uterine bleeding and dysmenorrhea since surgery. In imaging studies, she was diagnosed with uterine isthmocele, with minimal remaining tissue, a combined hysteroscopic and laparoscopic repair was performed. Endometriosis was identified in the istmocele scar tissue.