EP20.30: Ultrasound features of isthmocele resulting from Caesarean section before and after laparoscopic treatment

An isthmocele, also recognised as a Caesarean scar defect, is a condition increasingly acknowledged in women who have undergone previous Caesarean sections. It can result in postmenstrual abnormal uterine bleeding, pelvic pain, and infertility. Several surgical techniques are available. We report a case of isthmocele repair in a symptomatic patient following laparoscopic surgery (isthmoplasty), and we highlight the ultrasound features before and after the intervention. A 33yr old female (G5P3A2) came to our emergency complaining of postmenstrual bleeding. The patient had no complaints of abdominal pain. She had a history of 3 Caesarean sections. There is no other history of medical illness or surgery. She had regular menses every 30 days, with a moderate flow for 4-6 days. Her child capital is reached. The ultrasound examination revealed 3 x 2.5 cm hemorrhagic collection in the upper uterine cavity extending into a Caesarean scar, with a residual myometrial wall of 16mm suggesting isthmocele. Both the ovaries were normal. As a result, we performed a laparoscopic isthmocele repair. The patient's recovery after surgery proceeded without any complications. During the 40-day postoperative follow-up, both transvaginal and transabdominal ultrasonography revealed complete anatomical repair of the uterine defect, and the patient reported that postmenstrual spotting had resolved. Our case illustrates that the fundamental approach to managing isthmocele is to address the symptoms. Asymptomatic patients typically do not require treatment. Please note: The publisher is not responsible for the content or functionality of any supporting information supplied by the authors. Any queries (other than missing content) should be directed to the corresponding author for the article.