ISTHMOCELE MIMICKING HAEMATOMETRA: A RARE CASE REPORT

Dr. Twinkle Sood*

ABSTRACT

Isthmocele or caesarean scar defect appears as fluid filled pouch like defect at the site of previous caesarean section. It is formed as a result of incomplete healing of isthmic myometrium after a low transverse uterine incision performed for caesarean section. As the incidence of caesarean section is increasing so is the incidence of isthmocele. Most of the cases are asymptomatic though some patients may have pelvic pain, menstrual symptoms or secondary infertility. Diagnosis is usually incidental on a transvaginal ultrasonography (TVUS), hysterosalpingogram (HSG), saline infusion sonogram (SIS), hysteroscopy or MRI. Treatment of the defect is essential if patient is symptomatic. I report a case of 27 year P1+0 who presented with the complaint of postmenstrual spotting and pelvic pain for the past 1 year. On further investigations a probable diagnosis of either haematometra or an isthmocele was kept. Laparotomy was performed and patient was found to have isthmocele. The defect was repaired and the patient was discharged. This case aims at providing information to the clinicians regarding its unusual presentation, diagnosis and management.

Keywords: Isthmocele, caesarean scar defect, incomplete healing.