Three cases of successful operative treatment for cesarean scar syndrome

Abstract

  Cesarean scar syndrome (CSS) is caused by a defect in a prior cesarean section scar. Patients with CSS have gynecologic symptoms such as post-menstrual brown discharge, pelvic pain, and secondary infertility. We report three cases of CSS that received successful surgical treatment. Two cases showed post-menstrual brown discharge and one case showed a history of secondary infertility for four years. Transvaginal ultrasonography and magnetic resonance imaging indicated the cesarean scar defect and blood pooling. In all cases, we performed surgical treatment. We could not identify the cesarean scar defect by laparoscopy only. In two cases, we performed combined hysteroscopic and laparoscopic study, and in one case, we cut the myometrium vertically to identify the defect. Immediately after surgery, the post-menstrual brown discharge disappeared, and the case with secondary infertility achieved pregnancy six months after surgery. In conclusion, using hysteroscope or cutting the myometrium vertically was useful for identifying the defect.