Diagnosis of caesarean section scar niche causing chronic pelvic pain

Papa Dasari


The common causes of chronic pelvic pain include chronic pelvic inflammatory disease, endometriosis, inflammatory bowel disease etc. Caesarean scar defect is recently recognized as a cause for chronic pelvic pain. A 33 years old para 2 with previous 2 caesarean sections, whose last child birth was 18 months back consulted for rectal pain of 4 months duration. She was treated with progesterones with a provisional diagnosis of endometriosis without much relief. She developed congestive dysmenorrhea and dyspareunia after last child birth. Her clinical examination revealed retroverted uterus with left forniceal tenderness. USG evaluation confirmed the clinical findings and evaluation of uterine scar was not undertaken as the possibility of caesarean scar defect (CSD) was not thought of as a cause for chronic pelvic pain. MRI pelvis reported semicircular myometrial defect at LSCS scar site and this was confirmed by hystero-laparoscopy and she was counselled to undergo repair of CSD. The case illustrated the clinical picture and diagnosis of CSD as a cause for chronic pelvic pain.


Dysmennorrhea, Dyspareunia, Rectal pain, Previous 2 caesarean section, Caesarean scar defect

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