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Retained Products of Conception Sequestered in an Isthmocele

      A 33-year-old woman, G5, P1, was referred for surgical removal of retained products of conception after an incomplete abortion at 18 weeks gestation. After dilatation and evacuation, the patient re-presented to the hospital with severe abdominal pain. Sonography, and later magnetic resonance imaging, identified a very large tissue mass (8.3 × 7.7 × 5.7 cm), without fetal parts, entirely confined within a uterine isthmocele (Figure 1). A laparoscopic approach (Figure 2) allowed for temporary internal iliac artery ligation, extraction of 74 g of necrotic products of conception, and full-thickness reconstruction of the uterus. Blood loss was minimal (<50 mL), and the patient was discharged the same day. This case demonstrates that large volumes of tissue can be sequestered by an isthmocele after a miscarriage in an otherwise empty uterus.
      An isthmocele is a wedge-shaped area of discontinuation of the myometrium at the site of a cesarean scar, with a depth of at least 1 mm.
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      • Cohen A
      Emerging manifestations of cesarean scar defect in reproductive-aged women.
      Prevalence is reported at 61%, 81%, and 100% for women who have undergone 1, 2, and 3 cesarean deliveries, respectively.
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      High prevalence of defects in cesarean section scars at transvaginal ultrasound examination.
      The defect can be asymptomatic or present with abnormal bleeding, pelvic pain, and secondary infertility.
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      • et al.
      Isthmocele: from risk factors to management.
      Consent: Consent to publish these images was obtained from the patient.

      REFERENCES

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        J Minim Invasive Gynecol. 2016; 23: 893-902
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        High prevalence of defects in cesarean section scars at transvaginal ultrasound examination.
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      Linked Article

      • Produits de conception retenus dans une isthmocèle
        Journal of Obstetrics and Gynaecology Canada Vol. 44Issue 6
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          Une femme de 33 ans, G5P1, a été orientée pour le retrait chirurgical de produits de conception retenus à la suite d'un avortement incomplet à 18 semaines d'aménorrhée. Après la dilatation-aspiration, la patiente s'est présentée de nouveau à l'hôpital en raison de douleurs abdominales intenses. Une échographie, suivie d'une IRM, a permis de détecter une masse tissulaire très volumineuse (8,3 × 7,7 × 5,7 cm), sans partie fœtale, entièrement contenue dans une isthmocèle (figure 1). La voie laparoscopique (figure 2) a été utilisée pour réaliser la ligature temporaire de l'artère iliaque interne, l'extraction de 74 grammes de produits de conception nécrotiques et la reconstruction pleine épaisseur de l'utérus.
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