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 cesarean scar niche.
- mostly asymptomatic
- postmenstrual spotting
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
- 1. Surapaneni K, Silberzweig JE. Cesarean section scar diverticulum: appearance on hysterosalpingography. AJR Am J Roentgenol. 2008;190 (4): 870-4. doi:10.2214/AJR.07.2916 - Pubmed citation
- 2. Fabres C, Aviles G, De La Jara C et-al. The cesarean delivery scar pouch: clinical implications and diagnostic correlation between transvaginal sonography and hysteroscopy. J Ultrasound Med. 2003;22 (7): 695-700. J Ultrasound Med (full text) - Pubmed citation
- 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. doi:10.6001/actamedica.v23i4.3424 - Pubmed