ISSN : 2146-3123
E-ISSN : 2146-3131

Wenchao Sun1, Guier Chen2
1Center of Reproductive Medicine, Hangzhou Women’s Hospital, Hangzhou, China
2Department of Obstetrics and Gynecology, Hangzhou Women’s Hospital, Hangzhou, China
DOI : 10.4274/balkanmedj.galenos.2024.2024-6-5
Pages : 402-403

A 36-year-old female presented to our gynecology clinic with a two-week history of persistent lower abdominal pain. She had undergone a cesarean section 10 years ago on her request and experienced persistent postmenstrual spotting for one year. Physical examination revealed a tender uterus. Laboratory studies revealed a white cell count of 14,300/mm3 and a C-reactive protein level of 11.3 mg/L. Pelvic ultrasonography revealed a cystic mass in the lower segment of the uterus (Figure 1). Furthermore, pelvic magnetic resonance imaging revealed a cystic lesion measuring 5.1 x 4.2 x 4.0 cm at the site of the previous hysterotomy (Figure 2a). Reddish-brown pus was aspirated transvaginally (Figure 2b). These findings were consistent with an infected uterine diverticulum. The patient was administered intravenous ceftriaxone and metronidazole. Because the patient wanted a second child, a transvaginal uterine diverticulectomy was performed (Figure 2c-f). Postoperatively, her abdominal pain resolved completely. At the three-year follow-up, she was still pain-free. Informed consent was obtained from the patient for the publication of this report.

Uterine diverticula commonly develop after cesarean sections1,2 and are usually small and asymptomatic. A large infected diverticulum is rare3 and may cause abdominal pain, which was observed in our patient. In such patients, transvaginal uterine diverticulectomy is a feasible treatment option.

Informed Consent: Informed consent was obtained from the patient for the publication of this report.

Authorship Contributions: Concept- W.S. G.C.; Design- W.S.; Supervision- G.C.; Materials- W.S.; Data Collection and/or Processing- W.S. G.C.; Analysis and/or Interpretation- G.C.; Literature Search- W.S. G.C.; Writing- W.S.; Critical Review- G.C.

Conflict of Interest: No conflict of interest was declared by the authors.

REFERENCES

  1. Bi B, Gao S, Ruan F, et al. Analysis on clinical association of uterine scar diverticulum with subsequent infertility in patients underwent cesarean section. Medicine (Baltimore). 2021;100:e27531.
  2. Gozzi P, Hees KA, Berg C, et al. Frequency and associated symptoms of isthmoceles in women 6 months after caesarean section: a prospective cohort study. Arch Gynecol Obstet. 2023;307:841-848.
  3. Boukrid M, Dubuisson J. Conservative Management of a Scar Abscess formed in a Cesarean-induced Isthmocele. Front Surg. 2016;3:7.

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