PMC9842908_01
Trans vaginal ultrasonography shows an anechoic defect (red asterisk) in cesarean incision site.
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Transvaginal ultrasound showed a defect at the region of cesarean incision site being replaced by cystic lesion in anterior and right side with no vascularity noted within, with differential diagnosis of an isthmocele as shown in Figure 1.
Axial image of magnetic resonance imaging (MRI) of abdomen/pelvis shows loss of myometrial continuity (red arrow) with blood clot (purple asterisk) and intact serosa (green arrow). Bowels (red asterisk) and bladder (green asterisk) are also seen.
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Magnetic resonance imaging (MRI) revealed 3.2 x 2.4 x 2.9 cm non-enhancing lesion in anterior myometrium with extension to the endometrial cavity through a focal defect in the lower uterine segment with the intact serosa, features likely of contained rupture at previous cesarean scar site as shown in Figure 2.
Per operative image showing bulge at the previous scar site (black asterisk).
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She underwent laparotomy which revealed 2 x 2 cm bluish bulge at the previous scar site as shown in Figure 3.
Per operative image showing brownish material exposed after incising the bulge present at the previous scar site (black asterisk).
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Upon incising the bulge, brownish product of conception like material was revealed as depicted in Figures 4 and 5.
Gross specimen of removed scar tissue.
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Upon incising the bulge, brownish product of conception like material was revealed as depicted in Figures 4 and 5.
Gross specimen of product of conception like mass removed after incising the bulge present at previous scar site.
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The scar tissue was removed as shown in Figure 6 and the margins were freshened.
Per operative image showing uterus after the repair of isthmocele.
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The uterine cavity was difficult to visualize so, uterine sound was inserted and the uterine incision was closed in two layers as shown in Figure 7.