Recurrent Isthmocele Following Second Cesarean Section Delivery: A Case Report and Management Strategies

Background: Cesarean section (CS) rates are increasing globally, leading to heightened concern regarding associated adverse outcomes, including isthmocele formation. Isthmocele, a depression or defect in the anterior uterine wall at the CS scar site, can result in various complications, impacting women's quality of life and reproductive health. Methods: We present a case report of a 30-year-old woman who underwent emergency CS in 2019 and subsequently developed isthmocele. After experiencing lower abdominal pain, she underwent clinical and laboratory investigations followed by laparoscopic resection of the left ovary. Due to secondary infertility and the desire for future pregnancies, she underwent laparoscopic metroplasty. Results: Following metroplasty, the patient conceived naturally and had a successful pregnancy monitored as high-risk. She underwent cesarean section delivery without complications and was discharged postpartum. Subsequent ultrasound revealed the recurrence of isthmocele, highlighting the need for ongoing monitoring and intervention. Conclusion: This case underscores the importance of timely diagnosis and appropriate management of isthmocele, particularly in women desiring future pregnancies. Minimally invasive surgical techniques such as laparoscopic metroplasty can effectively treat isthmocele, facilitating successful pregnancies and improving maternal outcomes.