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This is the case of a 38 years old G2P2 patient with a history of 2 previous cesarean sections. She complained of postmenstrual spotting that had started after the second cesarean section performed 3 years before, lasted for 4-5 days and was more intense during micturition.

Caption: Longitudinal
Description: not provided
Caption: Longitudinal and transverse
Description: not provided
Differential Diagnosis not provided
Final Diagnosis Isthmocele
Discussion The "isthmocele" represents a possible consequence of one or more cesarean deliveries. This is due to the presence of a diverticulum on the anterior wall of the uterine isthmus or of the cervical canal at the site of a previous cesarean delivery scar. The obstetric complications that a cesarean delivery may produce have been known and studied for a long time. In the last few years, new correlations with some gynecologic disturbances have emerged, such as abnormal uterine bleeding (AUB) of the post-menstrual spotting type (PAUB) and with some cases of secondary infertility.
This defect can be easily diagnosed by transvaginal ultrasound and hysteroscopy and successfully treated by resectoscopic technique.
Case References Gubbini G, Casadio P, Marra E. Resectoscopic correction of the "isthmocele" in women with postmenstrual abnormal uterine bleeding and secondary infertility. J Minim Invasive Gynecol. 2008;15(2):172-5.
Follow Up Postmenstrual spotting disappeared after resectoscopic surgery.