Uterine Isthmocele: An Overview of Diagnosis and Treatment of a Large Isthmocele

Introduction: An isthmocele, also known as a cesarean scar defect or uterine niche, is a late complication of cesarean section. The majority of isthmoceles are asymptomatic, however it can manifest with chronic pelvic pain, abnormal menstruation or infertility. The objective of this review is to present the case of a patient with a large isthmocele, including its risk factors, symptoms, imaging, and therapeutic management. Materials and Methods: In this review, we present the case of a patient who presented a post caesarean large isthmocele taken in charge at the Gynecology Department of the Souissi Maternity of Rabat July 6. Results: The patient was 29 years old, who had two cesarean sections. She presented in our hospital with a pelvic pain and abnormal uterine bleeding (metrorrhagia). Her clinical examination was normal. Imaging studies (ultrasound, MRI) had revealed a voluminous isthmocele with a large diverticulum. A laparoscopy was proposed as a treatment for our patient but its realization was very difficult (excessive weight and adhesive pelvis), we converted to a laparotomy with resection of the isthmocele, drainage and closure of the residual cavity. The evolution was favorable with disappearance of the symptoms. Conclusion: Isthmocele is an anatomo clinical entity still lacking standardization in its diagnostic and therapeutic approaches. Therefore, it is important to know well one’s classification, whether the symptoms are noisy or not, to choose the right imaging for diagnosis, and to provide adequate management. The treatment currently relies on laparoscopic detection and correction of the isthmic defect.