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Abstract: After a cesarean section, the patient had poor recovery due to postpartum anemia caused by intraoperative hemorrhage, and she did not have menstruation until 10 months after delivery. After the hysteroscopic surgery to repair the scar diverticulum, the patient returned to normal menstruation after medication.
Basic information】Female, 34 years old
Disease Type】Uterine scar diverticulum
Hospital】Jiangbin Hospital of Guangxi Zhuang Autonomous Region
Date of consultation】April 2022
Treatment plan】Surgical treatment (hysteroscopic surgery to repair scar diverticulum) + intravenous medication (cefuroxime sodium for injection, metronidazole injection)
Treatment period】Hospitalization for 3 days, review after 1 month
Treatment effect] The patient’s abnormal menstrual symptoms disappeared and the treatment was effective
I. Initial interview
The patient reported that she had a cesarean section for placenta praevia in November 2019, with intraoperative hemorrhage and blood transfusion, and anemia in the postoperative examination, and her menstruation came only 10 months after delivery, with high menstrual volume, a menstrual period of about 10 days, irregular menstrual cycle, 35-50 days/time, and no dysmenorrhea. In the last six months, as her body recovered, her menstrual cycle became regular, 28-32 days/time, and her menstrual volume returned to normal. The patient had her menstrual period for 2 days and requested surgery at our hospital, and was diagnosed with uterine scar diverticulum.
II. Treatment process
After admission, the patient’s vital signs were normal, the examination related to surgery was completed, the routine hemoglobin was 106g/L, which was mild anemia, and the rest of the examination did not show any obvious abnormalities. The patient had no fertility requirements, and the least invasive and most economical surgical option was hysteroscopic surgery for the purpose of restoring normal menstruation. A diverticulum of about 15 mm in length was seen in the lower scar of the anterior uterine wall, and the edge of the diverticulum was repaired and the entrance of the diverticulum was widened and flattened.
III. Treatment results
The patient recovered well after the operation. 2 days after the operation, the patient’s vital signs were normal, no fever, abdominal pain, a little vaginal bleeding, which was normal, and the patient requested to be discharged, and was then discharged. More than 1 month after the operation, the patient returned to the hospital for follow-up after her menstrual flow had cleared, and a repeat ultrasound of the uterus showed that the scar diverticulum had become significantly shallower.
IV. Notes
We are glad that after the surgery, the patient’s scar diverticulum has become shallow and her menstrual period has returned to normal, but after discharge from the hospital, the following precautions should be kept in mind.
1.After surgery, patients are recommended to go to outpatient clinic for pelvic floor rehabilitation treatment to promote the growth of the uterine scar through electrical stimulation of the instrument, so that the trauma can grow more flat and recover better.
2. After surgery, patients need to rest more, do not work too hard, do not have intercourse too early, pay attention to the hygiene of the vulva and incision area to avoid infection, which will affect the healing of the wounds in the uterus.
3.Patients are advised to increase nutrition appropriately to promote body recovery and facilitate the return of normal menstruation.
4.The occurrence of scar diverticulum and menstrual disorders in the patient will easily affect the body and mind, so it is recommended to adjust the mentality.
V. Personal insight
Scar diverticulum is more common after cesarean section, but most patients ignore it because it is small and has no clinical symptoms. Many women find scar often because of physical examination, menstrual abnormalities and infertility, especially those with large scar diverticulum, which can easily lead to increased menstrual volume and menstrual dripping, etc. For women with clinical symptoms and causing infertility, they can choose surgical treatment with more definite effect. As with this patient, the condition was effectively controlled and improved after surgery.