Isthmocele
Overview
An isthmocele (also called a cesarean scar defect or niche) is a pouch-like defect that forms at the site of a previous cesarean section scar on the uterus.
Symptoms :
Spotting or bleeding between periods
Pain during or after menstruation
Difficulty in conceiving (infertility)
Abnormal discharge
Diagnostic evalution:
Transvaginal Ultrasound (TVS)
First-line investigation
A small fluid-filled pouch at the cesarean scar site is seen.
Saline Infusion Sonography (SIS) / Sonohysterography
Provides a clearer view of the defect size, depth, and shape.
Hysteroscopy
A thin telescope is passed through the cervix to directly visualize the uterine cavity and the niche opening.
MRI (Magnetic Resonance Imaging)
Used in complex cases.
Provides detailed images of the scar and surrounding tissues.
Management options:
The surgery can be done by one of the following methods:
Laparoscopic Repair: The defect is cut out and the uterus is repaired in layers.
Hysteroscopic Repair: Through the vagina and cervix using a thin telescope; suitable for small and shallow defects.
Combined Laparoscopic and Hysteroscopic Approach: In selected cases to ensure complete correction.
