Diagnosis of caesarean section scar niche causing chronic pelvic pain

Papa Dasari
In: International Journal of Reproduction, Contraception, Obstetrics and Gynecology · 2021 · vol. 10(9) , pp. 3623 · doi:10.18203/2320-1770.ijrcog20213500 · W3198450502
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⚙ AI-generated summary by gemini-2.5-flash-lite, 2026-06-10 ⓘ

This case report describes a 33-year-old woman with chronic pelvic pain successfully diagnosed with a caesarean scar defect via MRI and hystero-laparoscopy.

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⚙ AI-generated deep summary by claude@2026-06, 2026-06-10 · read from full text ⓘ

This paper describes a single 33-year-old woman with chronic rectal pain and subsequent congestive dysmenorrhea and dyspareunia after two prior caesarean sections, initially evaluated for endometriosis and treated with progesterones without relief. Because caesarean scar defect (CSD) was not considered, early assessment included pelvic exam and ultrasound findings that aligned with other clinical features but did not evaluate the uterine scar; MRI then identified a semicircular myometrial defect at the previous lower-segment caesarean scar site, later confirmed by hystero-laparoscopy. The major limitation is that the evidence is based on one case illustration rather than a systematic study. Relevance to endometriosis: endometriosis is explicitly mentioned as a provisional diagnosis that was considered and treated initially, though the final diagnosis in this paper was CSD rather than endometriosis.

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Abstract

The common causes of chronic pelvic pain include chronic pelvic inflammatory disease, endometriosis, inflammatory bowel disease etc. Caesarean scar defect is recently recognized as a cause for chronic pelvic pain. A 33 years old para 2 with previous 2 caesarean sections, whose last child birth was 18 months back consulted for rectal pain of 4 months duration. She was treated with progesterones with a provisional diagnosis of endometriosis without much relief. She developed congestive dysmenorrhea and dyspareunia after last child birth. Her clinical examination revealed retroverted uterus with left forniceal tenderness. USG evaluation confirmed the clinical findings and evaluation of uterine scar was not undertaken as the possibility of caesarean scar defect (CSD) was not thought of as a cause for chronic pelvic pain. MRI pelvis reported semicircular myometrial defect at LSCS scar site and this was confirmed by hystero-laparoscopy and she was counselled to undergo repair of CSD. The case illustrated the clinical picture and diagnosis of CSD as a cause for chronic pelvic pain.
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Diagnosis of caesarean section scar niche causing chronic pelvic pain DOI: https://doi.org/10.18203/2320-1770.ijrcog20213500Keywords: Dysmennorrhea, Dyspareunia, Rectal pain, Previous 2 caesarean section, Caesarean scar defectAbstract The common causes of chronic pelvic pain include chronic pelvic inflammatory disease, endometriosis, inflammatory bowel disease etc. Caesarean scar defect is recently recognized as a cause for chronic pelvic pain. A 33 years old para 2 with previous 2 caesarean sections, whose last child birth was 18 months back consulted for rectal pain of 4 months duration. She was treated with progesterones with a provisional diagnosis of endometriosis without much relief. She developed congestive dysmenorrhea and dyspareunia after last child birth. Her clinical examination revealed retroverted uterus with left forniceal tenderness. USG evaluation confirmed the clinical findings and evaluation of uterine scar was not undertaken as the possibility of caesarean scar defect (CSD) was not thought of as a cause for chronic pelvic pain. MRI pelvis reported semicircular myometrial defect at LSCS scar site and this was confirmed by hystero-laparoscopy and she was counselled to undergo repair of CSD. The case illustrated the clinical picture and diagnosis of CSD as a cause for chronic pelvic pain. Metrics References Wozniak A, Pyra K, Tinto HR, Wozniak S. Ultrasonographic criteria of cesarean scar defect evaluation. J Ultrason. 2018;18(73):162-5. Anaf V, Simon P, Nakadi I, Fayt I, Buxant F, Simonart T, et al. Relationship between endometriotic foci and nerves in rectovaginal endometriotic nodules. Hum Reprod. 2000;15(8):1744-50. Vervoort AJ, Uittenbogaard LB, Hehenkamp WJ, Brolmann HA, Mol BW, Huirne JA. Why do niches develop in Caesarean uterine scars? Hypotheses on the aetiology of niche development. Hum Reprod. 2015;30(12):2695-702. Jordans IPM, Leeuw RA, Stegwee SI, Amso NN, Soldevila PN, Bosch T, et al. Sonographic examination of uterine niche in non-pregnant women: a modified Delphi procedure. Ultrasound Obstet Gynecol. 2019;53(1):107-15. Voet LF, Vaate AM, Veersema S, Brolmann HA, Huirne JA. Long-term complications of caesarean section. The niche in the scar: a prospective cohort study on niche prevalence and its relation to abnormal uterine bleeding. BJOG. 2014;121(2):236-44. Wong WSF, Fung WT. Magnetic Resonance Imaging in the Evaluation of Cesarean Scar Defect. Gynecol Minim Invasive Ther. 2018;7(3):104-7. Vaate AJ, Brolmann HA, Voet LF, Slikke JW, Veersema S, et al. Ultrasound evaluation of the Cesarean scar: relation between a niche and postmenstrual spotting. Ultrasound Obstet Gynecol. 2011;37(1):93-9. Chen YY, Tsai CC, Kung FT, Lan KC, Ou YC. Association between hysteroscopic findings of previous cesarean delivery scar defects and abnormal uterine bleeding. Taiwan J Obstet Gynecol. 2019;58(4):541-4. Fabres C, Aviles G, Jara C, Escalona J, Munoz JF, Mackenna A, et al. The cesarean delivery scar pouch: clinical implications and diagnostic correlation between transvaginal sonography and hysteroscopy. J Ultrasound Med. 2003;22(7):695-700. Rao ST, Lambert N, Ghosh B, Chang T. Defining the limits of caesarean scar niche repair: new anatomical landmarks. Gynecolog Surg. 2021;18(1):1-2.

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endometriosischronic_pelvic_paindysmenorrheadyspareunia

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