Histeroskopik İstmosel Cerrahisinin Nadir Bir Komplikasyonu: Uterin Subserozal Apse Oluşumu
Year 2025,
Volume: 11 Issue: 1, 136 - 139
Şule Atalay Mert
,
Tuğba Kınay
,
Sait Erbey
,
Sinem Ece Kından
,
Hüseyin Levent Keskin
Abstract
ÖZ
İstmosel (niş) tanı ve tedavisi son yıllarda jinekolojide popüler bir konu haline gelmiştir. İstmosel tanı ve tedavisini değerlendiren çok sayıda makale olmasına rağmen cerrahi komplikasyonlar konusunda net bilgiler bulunmamaktadır. Bu çalışmada histeroskopik cerrahi onarım sonrası gelişen uterin apse olgusu sunulmaktadır. Literatürde istmosel cerrahisi sonrası peritoneal yüzeylerde apse olguları ve uterin perforasyon olguları bildirilirken, bizim olgumuz bildiğimiz kadarıyla istmosel cerrahisi sonrası kronik pelvik ağrıya neden olan uterus apsesinin ilk örneğidir. Bu olgu sunumunun amacı, klinisyenler arasında istmosel cerrahisi, artan prevalansı ve buna bağlı olası komplikasyonlar konusunda farkındalığı artırmaktır.
References
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- 2. Di Spiezio Sardo A, Saccone G, McCurdy R, Bujold E, Bifulco G, Berghella V. Risk of Cesarean scar defect following single- vs double-layer uterine closure: systematic review and meta-analysis of randomized controlled trials. Ultrasound Obstet Gynecol2017; 50(5):578-83.
- 3. Vervoort AJMW, Uittenbogaard LB, Hehenkamp WJK. Why do niches develop in Caesarean uterine scars? Hypotheses on the aetiology of niche development. Hum Reprod 2015; 30:2695–2702.
- 4. Vikhareva Osser O, Jokubkiene L, Valentin L.High prevalence of defects in Cesarean section scars at transvaginal ultrasound examination. Ultrasound Obstet Gynecol 2009; 34:90–97.
- 5. Iannone P, Nencini G, Bonaccorsi G, Martinello R, Pontrelli G, Scioscia M, Nappi L, Greco P, Scutiero G. Isthmocele: From Risk Factors to Management. Rev Bras Ginecol Obstet 2019; 41(1):44-52.
- 6. Tulandi T, Cohen A. Emerging Manifestations of Cesarean Scar Defect in Reproductive-aged Women. J Minim Invasive Gynecol 2016; 23:893–902.
- 7. Tower AM, Frishman GN. Cesarean scar defects: an underrecognized cause of abnormal uterine bleeding and other gynecologic complications. J Minim Invasive Gynecol 2013; 20:562–72.
- 8. Li C, Tang S, Gao X, Lin W, Han D, Zhai J, Mo X, Zhou LJ. Efficacy of Combined Laparoscopic and Hysteroscopic Repair of Post-Cesarean Section Uterine Diverticulum: A Retrospective Analysis. Biomed Res Int 2016; 2016:1765624.
- 9. Dominguez JA, Pacheco LA, Moratalla E, Carugno JA, Carrera M, Perez-Milan F, Caballero M, Alcázar JL. Diagnosis and management of isthmocele (Cesarean scar defect): a SWOT analysis. Ultrasound Obstet Gynecol 2023; 62(3):336-44.
- 10. Setúbal A, Alves J, Osório F, Sidiropoulou Z. Demonstration of Isthmocele Surgical Repair. J Minim Invasive Gynecol 2021; 28:389–90.
- 11. Vachon-Marceau C, Demers S, Bujold E, Roberge S, Gauthier RJ, Pasquier JC, Girard M, Chaillet N, Boulvain M, Jastrow N. Single versus double-layer uterine closure at cesarean: impact on lower uterine segment thickness at next pregnancy. Am J Obstet Gynecol 2017 ;217(1):65.e1-65.e5.
- 12. Bujold E, Jastrow N, Simoneau J, Brunet S, Gauthier RJ. Prediction of complete uterine rupture by sonographic evaluation of the lower uterine segment. Am J Obstet Gynecol 2009; 201(3): 320.e1-6.
- 13. Kulshrestha V, Agarwal N, Kachhawa G. Post-caesarean Niche (Isthmocele) in Uterine Scar: An Update. Journal of Obstetrics and Gynecology of India 2020; 70:440–46.
- 14. Boukrid M, Dubuisson J. Conservative Management of a Scar Abscess formed in a Cesarean-induced Isthmocele. Front Surg 2016; 3:7.
A Rare Complication of Hysteroscopic Isthmocele Surgery: Uterine Subserosal Abscess Formation
Year 2025,
Volume: 11 Issue: 1, 136 - 139
Şule Atalay Mert
,
Tuğba Kınay
,
Sait Erbey
,
Sinem Ece Kından
,
Hüseyin Levent Keskin
Abstract
ABSTRACT
Diagnosing and treating isthmocele (niche) has become a popular topic in gynecology in recent years. While numerous articles evaluate isthmocele diagnosis and treatment, there is a lack of clear information on surgical complications. This study presents a case of a uterine abscess that developed after hysteroscopic surgical repair. While the literature reports abscess cases on peritoneal surfaces and uterine perforation cases occurring after isthmocele surgery, to the best of our knowledge, our case is the first instance of a uterine abscess causing chronic pelvic pain after isthmocele surgery. The purpose of this case report is to increase awareness among clinicians regarding isthmocele surgery, its growing prevalence, and the potential complications associated with it.
References
- 1. Poidevin Lo. The value of hysterography in the prediction of cesarean section wound defects. Am J Obstet Gynecol 1961; 81:67–71.
- 2. Di Spiezio Sardo A, Saccone G, McCurdy R, Bujold E, Bifulco G, Berghella V. Risk of Cesarean scar defect following single- vs double-layer uterine closure: systematic review and meta-analysis of randomized controlled trials. Ultrasound Obstet Gynecol2017; 50(5):578-83.
- 3. Vervoort AJMW, Uittenbogaard LB, Hehenkamp WJK. Why do niches develop in Caesarean uterine scars? Hypotheses on the aetiology of niche development. Hum Reprod 2015; 30:2695–2702.
- 4. Vikhareva Osser O, Jokubkiene L, Valentin L.High prevalence of defects in Cesarean section scars at transvaginal ultrasound examination. Ultrasound Obstet Gynecol 2009; 34:90–97.
- 5. Iannone P, Nencini G, Bonaccorsi G, Martinello R, Pontrelli G, Scioscia M, Nappi L, Greco P, Scutiero G. Isthmocele: From Risk Factors to Management. Rev Bras Ginecol Obstet 2019; 41(1):44-52.
- 6. Tulandi T, Cohen A. Emerging Manifestations of Cesarean Scar Defect in Reproductive-aged Women. J Minim Invasive Gynecol 2016; 23:893–902.
- 7. Tower AM, Frishman GN. Cesarean scar defects: an underrecognized cause of abnormal uterine bleeding and other gynecologic complications. J Minim Invasive Gynecol 2013; 20:562–72.
- 8. Li C, Tang S, Gao X, Lin W, Han D, Zhai J, Mo X, Zhou LJ. Efficacy of Combined Laparoscopic and Hysteroscopic Repair of Post-Cesarean Section Uterine Diverticulum: A Retrospective Analysis. Biomed Res Int 2016; 2016:1765624.
- 9. Dominguez JA, Pacheco LA, Moratalla E, Carugno JA, Carrera M, Perez-Milan F, Caballero M, Alcázar JL. Diagnosis and management of isthmocele (Cesarean scar defect): a SWOT analysis. Ultrasound Obstet Gynecol 2023; 62(3):336-44.
- 10. Setúbal A, Alves J, Osório F, Sidiropoulou Z. Demonstration of Isthmocele Surgical Repair. J Minim Invasive Gynecol 2021; 28:389–90.
- 11. Vachon-Marceau C, Demers S, Bujold E, Roberge S, Gauthier RJ, Pasquier JC, Girard M, Chaillet N, Boulvain M, Jastrow N. Single versus double-layer uterine closure at cesarean: impact on lower uterine segment thickness at next pregnancy. Am J Obstet Gynecol 2017 ;217(1):65.e1-65.e5.
- 12. Bujold E, Jastrow N, Simoneau J, Brunet S, Gauthier RJ. Prediction of complete uterine rupture by sonographic evaluation of the lower uterine segment. Am J Obstet Gynecol 2009; 201(3): 320.e1-6.
- 13. Kulshrestha V, Agarwal N, Kachhawa G. Post-caesarean Niche (Isthmocele) in Uterine Scar: An Update. Journal of Obstetrics and Gynecology of India 2020; 70:440–46.
- 14. Boukrid M, Dubuisson J. Conservative Management of a Scar Abscess formed in a Cesarean-induced Isthmocele. Front Surg 2016; 3:7.