Hysteroscopic management of uterine diverticulum after myomectomy: a case report
Abstract Background A uterine diverticulum is defined as the presence of a niche within the inner contour of the uterine myometrial wall. Although secondary uterine diverticula can occur after hysterotomy such as cesarean section, reports of diverticula after myomectomy are extremely rare. Case pres...
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| Format: | Article |
| Language: | English |
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BMC
2023-08-01
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| Series: | BMC Women's Health |
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| Online Access: | https://doi.org/10.1186/s12905-023-02606-7 |
| _version_ | 1827633291366236160 |
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| author | Yusuke Sako Tetsuya Hirata |
| author_facet | Yusuke Sako Tetsuya Hirata |
| author_sort | Yusuke Sako |
| collection | DOAJ |
| description | Abstract Background A uterine diverticulum is defined as the presence of a niche within the inner contour of the uterine myometrial wall. Although secondary uterine diverticula can occur after hysterotomy such as cesarean section, reports of diverticula after myomectomy are extremely rare. Case presentation A 45-year-old nulliparous woman undergoing infertility treatment was referred to our hospital because of abnormal postmenstrual bleeding after myomectomy. Transvaginal sonography and magnetic resonance imaging revealed a diverticulum in the isthmus. Fat-saturated T1 image showed a blood reservoir in the diverticulum. Hysteroscopic surgery was performed to remove the lowed edge of the defect and coagulate the hypervascularized area. Two months after surgery, the abnormal postmenstrual bleeding and chronic endometritis improved. Discussion and conclusions This report highlights the similarities of the patient’s diverticulum to cesarean scar defects in terms of symptoms and pathophysiology. First, this patient developed a diverticulum with hypervascularity after myomectomy and persistent abnormal bleeding. Second, after hysteroscopic surgery, the symptoms of irregular bleeding disappeared. Third, endometrial glands were identified within the resected scar tissue. Fourth, preoperatively identified CD138-positive cells in endometrial tissue spontaneously disappeared after hysteroscopic resection. To the best of our knowledge, this is the first report of symptomatic improvement following hysteroscopic surgery in a patient with an iatrogenic uterine diverticulum with persistent irregular bleeding after myomectomy. |
| first_indexed | 2024-03-09T14:57:29Z |
| format | Article |
| id | doaj.art-c498b41ca7df45868644a006b4219c51 |
| institution | Directory Open Access Journal |
| issn | 1472-6874 |
| language | English |
| last_indexed | 2024-03-09T14:57:29Z |
| publishDate | 2023-08-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Women's Health |
| spelling | doaj.art-c498b41ca7df45868644a006b4219c512023-11-26T14:06:31ZengBMCBMC Women's Health1472-68742023-08-012311510.1186/s12905-023-02606-7Hysteroscopic management of uterine diverticulum after myomectomy: a case reportYusuke Sako0Tetsuya Hirata1Department of Obstetrics and Gynecology, St Luke’s International HospitalDepartment of Obstetrics and Gynecology, St Luke’s International HospitalAbstract Background A uterine diverticulum is defined as the presence of a niche within the inner contour of the uterine myometrial wall. Although secondary uterine diverticula can occur after hysterotomy such as cesarean section, reports of diverticula after myomectomy are extremely rare. Case presentation A 45-year-old nulliparous woman undergoing infertility treatment was referred to our hospital because of abnormal postmenstrual bleeding after myomectomy. Transvaginal sonography and magnetic resonance imaging revealed a diverticulum in the isthmus. Fat-saturated T1 image showed a blood reservoir in the diverticulum. Hysteroscopic surgery was performed to remove the lowed edge of the defect and coagulate the hypervascularized area. Two months after surgery, the abnormal postmenstrual bleeding and chronic endometritis improved. Discussion and conclusions This report highlights the similarities of the patient’s diverticulum to cesarean scar defects in terms of symptoms and pathophysiology. First, this patient developed a diverticulum with hypervascularity after myomectomy and persistent abnormal bleeding. Second, after hysteroscopic surgery, the symptoms of irregular bleeding disappeared. Third, endometrial glands were identified within the resected scar tissue. Fourth, preoperatively identified CD138-positive cells in endometrial tissue spontaneously disappeared after hysteroscopic resection. To the best of our knowledge, this is the first report of symptomatic improvement following hysteroscopic surgery in a patient with an iatrogenic uterine diverticulum with persistent irregular bleeding after myomectomy.https://doi.org/10.1186/s12905-023-02606-7Uterine diverticulumHysteroscopic surgeryMyomectomyCesarean scar defect |
| spellingShingle | Yusuke Sako Tetsuya Hirata Hysteroscopic management of uterine diverticulum after myomectomy: a case report BMC Women's Health Uterine diverticulum Hysteroscopic surgery Myomectomy Cesarean scar defect |
| title | Hysteroscopic management of uterine diverticulum after myomectomy: a case report |
| title_full | Hysteroscopic management of uterine diverticulum after myomectomy: a case report |
| title_fullStr | Hysteroscopic management of uterine diverticulum after myomectomy: a case report |
| title_full_unstemmed | Hysteroscopic management of uterine diverticulum after myomectomy: a case report |
| title_short | Hysteroscopic management of uterine diverticulum after myomectomy: a case report |
| title_sort | hysteroscopic management of uterine diverticulum after myomectomy a case report |
| topic | Uterine diverticulum Hysteroscopic surgery Myomectomy Cesarean scar defect |
| url | https://doi.org/10.1186/s12905-023-02606-7 |
| work_keys_str_mv | AT yusukesako hysteroscopicmanagementofuterinediverticulumaftermyomectomyacasereport AT tetsuyahirata hysteroscopicmanagementofuterinediverticulumaftermyomectomyacasereport |