title: Successful treatment of atypical cesarean scar defect using endoscopic surgery.
abstract: BACKGROUND
  Cesarean scar syndrome results from a postoperative defect of the uterine isthmus, also known as an isthmocele. Patients present with gynecological symptoms, such as abnormal genital bleeding or infertility, after cesarean delivery. Although the cesarean rate is increasing worldwide, this syndrome is not widely known.
  
  
  METHODS
  A 43-year-old G2P1 Japanese woman with atypical cesarean scar syndrome had a 3-year history of secondary infertility and postmenstrual brown discharge. Laparoscopic and hysteroscopic exploration revealed a cesarean scar defect connected to a small cavity in the myometrium: this was not an endometrial cavity or a uterine diverticulum. After endoscopic excision of the cavity, the brown discharge resolved, and the patient achieved ongoing pregnancy on her third attempt at intrauterine insemination.
  
  
  CONCLUSIONS
  Consensus is still lacking regarding the diagnosis and treatment of cesarean scar defect. However, the gynecologists should be aware that cesarean scar syndrome can have scar defects forming cavities of unusual shapes and features. Surgical correction of these defects will often improve postmenstrual bleeding and subfertility in these cases.
authors.affiliation: Department of Obstetrics and Gynecology, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan. hirotaka@a3.keio.jp.
authors.forename: Hirotaka
authors.initials: H
authors.lastname: Masuda
authors.affiliation: Department of Obstetrics and Gynecology, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan. uchida@a5.keio.jp.
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Uchida
authors.affiliation: Department of Obstetrics and Gynecology, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan. tetsuo@a5.keio.jp.
authors.forename: Tetsuo
authors.initials: T
authors.lastname: Maruyama
authors.affiliation: Department of Obstetrics and Gynecology, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan. ksato@a8.keio.jp.
authors.forename: Kenji
authors.initials: K
authors.lastname: Sato
authors.affiliation: Department of Obstetrics and Gynecology, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan. suguru_sato@mac.com.
authors.forename: Suguru
authors.initials: S
authors.lastname: Sato
authors.affiliation: Department of Obstetrics and Gynecology, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan. mtanaka@a6.keio.jp.
authors.forename: Mamoru
authors.initials: M
authors.lastname: Tanaka
mesh_terms: D000328:Adult; D002585:Cesarean Section / Q000009:adverse effects*; D002921:Cicatrix / Q000601:surgery*; D004724:Endoscopy / Q000379:methods*; D005260:Female; D005307:Fertilization in Vitro; D006801:Humans; D007247:Infertility, Female; D011247:Pregnancy; D014599:Uterus / Q000601:surgery*