Cesarean section scar diverticulum

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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.

Clinical presentation

  • mostly asymptomatic
  • postmenstrual spotting

Radiographic features

Diagnosis is made mainly with transvaginal ultrasound in postmenstrual period. Sonohysterography is the best for diagnosis. Less commonly used modalities include hysterosalpingography and MRI.

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 :

  • 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  

Differential diagnosis