Cesarean section scar diverticulum
Updates to Article Attributes
Body
was changed:
Cesarean section scar diverticulum is a form of outpouching located in the anterior lower uterine cavity at the site of cesarean section scar.
There is some similarity with the term Cesareancesarean scar niche.
Clinical presentation
- mostly asymptomatic
- postmenstrual spotting
Radiographic features
Can be imaged onDiagnosis is made mainly with transvaginal ultrasound in postmenestrual period. Sonohysterography is the best for diagnosis. Less commonly used modalities include hysterosalpingography and ultrasonographyMRI.
There may be a U or V-shaped defect or a focal outpouching at the site of a prior cesarean section with >2 mm depth, base on the endometrial cavity and apex towards the anterior wall of the isthmus. Location can be in the lower uterine segment or upper endocervical canal.
Management and prognosis
Surgical options are only for symptomatic patients and include 3:
-
endoscopic isthmorrhaphy (isthmoplasty)
- can be done laparascopic or hystroscopic or combined
- usually done if residual myometrial thickness is less than 3 mm
- open repair: if endoscopic facilities or experience is not available
- less common: hystrectomy
Differential diagnosis
-
prominent cervical glandsNabothian cyst - post myomectomy diverticula
- Gartner duct cyst: long, tubular structure parallel to the uterine cavity
- adenomytic cyst: location of defect anywhere along uterine cavity
-<p><strong>Cesarean section scar diverticulum</strong> is a form of outpouching located in the anterior lower <a href="/articles/uterus">uterine cavity</a> at the site of cesarean section scar. </p><p>There is some similarity with the term <a href="/articles/cesarean-scar-niche">Cesarean scar niche</a>.</p><h4>Clinical presentation</h4><ul>- +<p><strong>Cesarean section scar diverticulum</strong> is a form of outpouching located in the anterior lower <a href="/articles/uterus">uterine cavity</a> at the site of cesarean section scar. </p><p>There is some similarity with the term <a href="/articles/cesarean-scar-niche">cesarean scar niche</a>.</p><h4>Clinical presentation</h4><ul>
-</ul><h4>Radiographic features</h4><p>Can be imaged on <a href="/articles/hysterosalpingogram">hysterosalpingography</a> and ultrasonography.</p><p>There may be a defect or a focal outpouching at the site of a prior cesarean section. Location can be in the lower uterine segment or upper endocervical canal.</p><h4>Differential diagnosis</h4><ul>-<li>prominent cervical glands </li>- +</ul><h4>Radiographic features</h4><p>Diagnosis is made mainly with transvaginal ultrasound in postmenestrual period. <a title="Sonohysterography" href="/articles/sonohysterography">Sonohysterography</a> is the best for diagnosis. Less commonly used modalities include <a href="/articles/hysterosalpingogram">hysterosalpingography</a> and MRI.</p><p>There may be a U or V-shaped defect or a focal outpouching at the site of a prior cesarean section with >2 mm depth, base on the endometrial cavity and apex towards the anterior wall of the isthmus. Location can be in the lower uterine segment or upper endocervical canal.</p><h4>Management and prognosis</h4><p>Surgical options are only for symptomatic patients and include <sup>3</sup>:</p><ul>
- +<li>endoscopic isthmorrhaphy (isthmoplasty)<ul>
- +<li>can be done laparascopic or hystroscopic or combined</li>
- +<li>usually done if residual myometrial thickness is less than 3 mm</li>
- +</ul>
- +</li>
- +<li>open repair: if endoscopic facilities or experience is not available</li>
- +<li>less common: hystrectomy </li>
- +</ul><h4>Differential diagnosis</h4><ul>
- +<li><a title="Nabothian cyst" href="/articles/nabothian-cyst">Nabothian cyst </a></li>
-<a href="/articles/adenomyosis">adenomyosis</a>: location of defect anywhere along uterine cavity</li>- +<a title="Cystic adenomyosis" href="/articles/cystic-adenomyosis">adenomytic cyst</a>: location of defect anywhere along uterine cavity</li>
References changed:
- 3. Bakavičiūtė G, Špiliauskaitė S, Meškauskienė A et-al. Laparoscopic repair of the uterine scar defect - successful treatment of secondary infertility: a case report and literature review. (2016) Acta medica Lituanica. 23 (4): 227-231. <a href="https://doi.org/10.6001/actamedica.v23i4.3424">doi:10.6001/actamedica.v23i4.3424</a> - <a href="https://www.ncbi.nlm.nih.gov/pubmed/28356813">Pubmed</a> <span class="ref_v4"></span>
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