The increase in caesarean sections makes it increasingly common for young patients to have postmenstrual bleeding.
The isthmocele consists of defective healing after the surgical opening of the uterus. It happens on many occasions after a cesarean section, that a pseudo bag appears in the surgical suture inside the uterus in which menstrual blood tends to stagnate.
Some studies have quantified that appears after a first cesarean section in 60% of cases, and after three cesarean sections in 100%.
Symptoms
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Not all istmoceles present clinical symptoms, but the most frequent is:
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Abnormal postmenstrual uterine bleeding (Most frequent symptom), the losses are due to the fact that the menstrual blood is collected in a kind of bag that is formed due to the loss of endometrial tissue and is gradually released . Often the blood comes out when you exercise or have sexual intercourse.
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Dyspareunia (pain in relationships)
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Dysmenorrhea (pain in menstruation)
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Chronic pelvic pain
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Abdominal pain
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Secondary sterility, the persistence of menstrual flow at the cervical level can negatively influence cervical mucus, interfering with semen quality and hindering the passage of sperm. The retained menstrual flow can also occupy the intrauterine cavity creating a bad endometrial environment and making it difficult for the embryo to implant.
problems it causes
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Secondary sterility or infertility
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Implantation interference
Diagnosis
The diagnosis is clinical and is made by endovaginal ultrasound and hysteroscopy.
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La hysteroscopyIt is the star technique for diagnosis, since it shows the defect directly, as well as its severity and allows to decide if it should be used for its technical correction _cc781905-5cde- 3194-bb3b-136bad5cf58d_of hysteroscopic or laparoscopic resection.
Treatment
The treatment of isthmocele is quirúrgico in cases with clinical symptoms or in cases of infertility with no other known cause.
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If it is performed by a hysteroscopic resectoscopy the pseudo-pocket defect is reduced and the surgical bed is coagulated for its closure.
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When the defect is very wide and deep and it is not possible to solve it by hysteroscopy, it is performed via laparoscopy, suturing said defect.
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After performing the technique, the pregnancy is achieved naturally in most cases a few months after surgery.
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The surgical resolution of the isthmocele solves postmenstrual metrorrhagia symptoms, disappearing or decreasing in the vast majority of patients