The team of gynecologists at Paras Bliss Hospital successfully treated a complex cervical polyp with Isthmocele, successfully. 37 yr old patient, Mrs Geeta Sharma a resident of Panchkula has a history of severe menstrual bleeding and spotting even after periods. In addition she complained of menstrual cramps and pain during intercourse. She was married for the last 12 yrs and had a 10 yr old son whom she had given birth through caesarean delivery. Doctors at Paras Bliss Hospital Panchkula studied her case in detail and post a MRI and Ultrasound diagnosed the cause to be – Isthmocele.
According to Geeta, “The pain was excruciating. During my periods I could neither walk or o any household activities. The excessive bleeding made me feel tired and drained all the time.”
Dr Monica Agarwal, Consultant Obstetrics & Gynecology at Paras Bliss Hospital Panchkula shares, “The patient had a scar in the uterus due to her previous caesarean delivery. In ultrasound a cervical polyp was seen and a pouch in anterior wall of uterus indenting in the urinary bladder with a size of 25*15 mm. Through an MRI the polyp was further investigated. In recent years, uterine isthmocele has increasingly been included as part of the differential in women with a history of a cesarean section who present with postmenstrual bleeding, pelvic pain, or secondary infertility.
The defect appears as a fluid-filled, pouch-like abnormality in the anterior uterine wall at the site of a prior cesarean section. Such a condition needs immediate medical attention along with surgery.”
The team of gynecologists headed by Dr Monica Agarwal decided to perform a Hysteroscopic Polypectomy with Laparoscopic Isthmocele Repair. A complex procedure through which the polyp is removed, easing the symptoms of pain and menstrual bleeding.
Dr Monica shares, “ The procedure involves laparoscopic surgery in which the abdomen is approached through 4 ports. The dissection of the previous scar created due to a c section delivery is done and the bladder is separated. The hysteroscope highlights the area and the excision of the polyp is done.”
Geeta was operated by a team of specialized doctors and was fit to be discharged in 2 days. She shares, “The surgery was smooth and I felt comfortable and at ease at all times. Dr Monica and her team ensured that I get the best attention. She was there to take care of my family’s apprehensions and also ensured that at all times my husband is duly informed about my progress. I am thankful to her for giving me my life back.”
Dr Monica also shares that condition is called ‘caesarean scar defect’ or ‘caesarean scar pouch’. It can be a risk factor for morbidly adherent placenta. Prolonged labour, advanced cervical dilatation, oxytocin use and retroverted uterus are few of the other risk factors. For treating the same a combined hysteroscopic and laparoscopic approach is the best. She further states, “Correct diagnosis, good preoperative strategy should be there to improve treatment. Laparoscopic repair is the most appropriate method of treatment as it can contribute to resolution of symptoms due to isthmocele, positive pregnancy after treatment and prevention of uterine rupture during pregnancy due to weak scar. So it should be managed by an experienced laparoscopic surgeon and a properly equipped hospital.”