What is Isthmocele (Caesarean Scar Disease)?

What is Isthmocele (Caesarean Scar Disease)?

An isthmocele (cesarean scar defect) is a pouch or pocket that forms in the anterior wall of the uterus. Isthmocele or cesarean scar disease can be defined as the condition of separation at the seams and the formation of a pouch, as a result of poor healing at the site that was cut to remove the baby and then sutured during cesarean delivery. An isthmocele usually occurs on the anterior wall of the uterus, just above the lower end of the uterus. The exact frequency is not known, but it is thought to be more common than anticipated. develops an isthmocele. Today, as cesarean section rates increase, it has become more common.

What are the Symptoms of Isthmocele?

If the following complaints are seen in people who have had at least one cesarean section before, can be doubted. These symptoms are as follows:

The presence of dark brown (mud-like) vaginal bleeding that continues for a while after the end of the menstrual bleeding

Inability to conceive after an uneventful pregnancy in the past (secondary infertility)


Pain during menstruation,

Excessive pain during sexual intercourse

Bad-smelling and dark colored discharge

As a result of embryo implanting in this pocket despite protection after cesarean section ectopic cesarean scar pregnancy occurrence

Women who experience these complaints after cesarean section should definitely be examined by a specialist physician. In some patients, isthmocele does not show any symptoms.

If there is a history of vaginal bleeding and cesarean section that lasts for a long time, which is black or dark brown in color, it should definitely be considered!!!

The number and severity of these symptoms should be considered from person to person. It can vary from person to person. The most common symptoms include long-lasting spotting bleeding, pain in the pelvic region, vaginal discharge, pain during menstruation, ectopic pregnancy as a result of the embryo implanting in this pocket, pain during sexual intercourse, and female-induced infertility. Isthmocele can cause women to experience mostly foul-smelling vaginal discharges of varying consistency and colour, to experience groin pain, and to notice brown discharge that persists for a while after the menstrual period is over. Especially in blotchy bleeding, which covers a very large part of the month, if the patient has previously If there is a history of cesarean section, it should definitely come to mind. Women who experience these symptoms and have difficulty conceiving after a cesarean delivery may need to seek medical advice.

What are the complications of an isthmocele?

Potential complications may include:


•   Increased risk of complications during gynecological procedures.

•  Placenta accreta (the placenta attaches too deeply to the wall of your uterus). /p>

•   Scar pregnancy (ectopic pregnancy in which the embryo implants within a uterine scar).

•  Infertility (infertility after a previous successful pregnancy). rupture.

Does Isthmocele Cause Infertility?

Isthmocele, which can occur shortly after or after a cesarean delivery, can cause infertility. Just like the Hydrosalpenx (inflamed tubes), it is accepted that in some of the women diagnosed with Isthmocele (how much is unknown at the moment), the inflammatory condition in these sacs may damage the sperm and disrupt the embryo's implantation process in the uterus.

Cesarean Section Scar Defect (Istmocele) Treatment

Which method will be chosen in the treatment of isthmocele is determined by the physician depending on the following factors:

1.The size of the istmocele defect

2. Whether the patient has a future pregnancy desire

3,Thickness of the uterine muscle layer after istmocele

Effective treatment of ismocele; It can prevent different diseases that may develop in the future due to infertility or abnormal bleeding.

There are various treatments for isthmoceles, including:

Hysteroscopic resection: Incision or suture not used.

Without making any incisions to the defective area, it is visualized by entering the uterus with an optical instrument. The pouch is corrected with this instrument. It is suitable for those whose uterine muscle wall is larger than 5mm, who do not plan to get pregnant again, and those who have abnormal vaginal bleeding. The surgery takes about 30 minutes and p; The patient is discharged home the same day.

Laparoscopic repair: The scar tissue and excess tissue around the niche are removed. Laparoscopic repair is a minimally invasive surgery for cesarean scar defects.

Uterine removal: A hysterectomy (womb removal) is for people with severe isthmocele symptoms who do not want to get pregnant again. You may be able to have a laparoscopic hysterectomy. This minimally invasive procedure uses smaller incisions than the open abdominal procedure.

As a result, you may have an isthmocele if you have had a previous cesarean delivery and continue to have vaginal bleeding that does not stop after menstruation, or if you are having trouble conceiving. I recommend you to apply to an experienced specialist in this regard and wish you healthy days.

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