Caesarean section scar diverticulum is a form of outpouching located in the anterior lower uterine cavity at the site of a caesarean section scar.
There is some similarity with the term caesarean scar niche.
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Clinical presentation
mostly asymptomatic
postmenstrual spotting
Radiographic features
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 caesarean 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.
Treatment and prognosis
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
Differential diagnosis
Gartner duct cyst: long, tubular structure parallel to the uterine cavity
adenomyotic cyst: defect can be located anywhere along the uterine cavity
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