부산대학교 도서관

Cesarean scar defect is a known complication of cesarean delivery. It has been associated with persistent, prolonged genital bleeding, chronic pelvic pain including menstrual pain, and secondary infertility. These symptoms have been closely investigated and referred to cesarean scar syndrome (CSS). The clinical significance of this disease remains unclear. Here, we report a case of a 33-year-old woman who presented with urinary pain, menstrual pain, and irregular bleeding after a second cesarean delivery. Her blood test revealed an elevated inflammatory response (WBC, 9.5×103/μl ; CRP, 2.16 mg/ml) and transvaginal ultrasound and MRI showed that the residual myometrial thickness (RMT) was very thin (1.0 mm), and there was a pooling of blood in a cesarean scar defect. After intravenous administration of ceftriaxone (2g/day), the inflammatory response improved. After treatment with GnRH agonist (1.88 mg, four weeks, three cycles), the RMT was increased to 4.8 mm. However, since urinary pain had not ameliorated, surgical intervention was required. Laparoscopic surgery in combination with hysteroscopy was performed and the cesarean scar defect was resected. Pathological finding included endometrial glandular structures in the resected myometrium. Taken together, CSS, at least a part of the cases, can be interpreted as a condition similar to that of uterine adenomyosis and treated by endocrine drugs and surgical therapy. [Adv Obstet Gynecol, 73 (3) : 271-276, 2021 (R3.8)]