Cesarean section scar diverticulum

Last revised by Mohammad Taghi Niknejad on 19 Dec 2023

Cesarean section scar diverticulum is a form of outpouching located in the anterior lower uterine cavity at the site of a cesarean section scar. 

There is some similarity with the term cesarean scar niche.

  • mostly asymptomatic

  • postmenstrual spotting

The diagnosis is made mainly with transvaginal ultrasound in the postmenstrual period. Sonohysterography is the best for diagnosis. Less commonly used modalities include hysterosalpingography and MRI.

It appears as a U or V shaped defect or a focal outpouching at the site of a prior cesarean section with >2 mm depth, with the base at the endometrial cavity and apex towards the anterior wall of the isthmus. It may be located within the lower uterine segment or upper endocervical canal.

Surgical options are only for symptomatic patients and include 3:

  • endoscopic isthmorrhaphy (isthmoplasty)

    • can be done via laparoscopy, hysteroscopy, or combined

    • usually done if the residual myometrial thickness is <3 mm

  • open repair: if endoscopic facilities are unavailable

  • less common: hysterectomy

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