What causes a cesarean scar憩室 (cesarean scar defect)?

Sep 29, 2024 Source: Cainiu Health

Dr. Zhang Lu

Introduction

Uterine fibroids are benign tumors arising from smooth muscle cells of the uterus. If located near a uterine scar, they may compress the scar or compromise its blood supply, leading to poor healing and the formation of a diverticulum. Symptoms may include menorrhagia, abdominal pain, and frequent urination. Doctors generally recommend surgical removal of the fibroid, followed by either conservative management or surgical repair depending on the condition of the diverticulum.

Uterine incisional diverticulum is a pathological condition resulting from poor healing of the uterine incision due to various factors during cesarean section. In general, it may be caused by improper wound suturing, incorrect placement of the uterine incision, endometriosis, uterine fibroids, infection, and other factors. If abnormalities occur, timely medical consultation is recommended. Specific analyses are as follows:

1. Poor Incision Suturing

During cesarean section, improper suturing techniques—such as overly tight or loose sutures—may lead to the formation of a uterine incisional diverticulum. Small diverticula can be monitored through regular follow-up; large diverticula or those causing symptoms require surgical repair. During surgery, suture issues should be carefully examined and corrected, with resuturing performed if necessary.

2. Improper Uterine Incision Placement

If the uterine incision is placed too high or too low during cesarean section, it may impair blood supply to the lower uterine segment, leading to poor wound healing and diverticulum formation. If the diverticulum is small and asymptomatic, regular monitoring is sufficient. However, if the diverticulum is large or associated with abnormal bleeding or other symptoms, surgical repair may be required. Common procedures include abdominal or transvaginal excision of the uterine diverticulum.

3. Endometriosis

Postoperative obstruction of intrauterine contents or implantation of endometrial tissue at the incision site can lead to repeated shedding and bleeding of endometrial tissue during menstruation, increasing local pressure at the incision and resulting in diverticulum formation. This may be accompanied by dysmenorrhea, painful intercourse, and infertility. Pain relief and anti-inflammatory medications such as ibuprofen sustained-release capsules, diclofenac sodium sustained-release tablets, or meloxicam tablets may be used as directed by a physician.

4. Uterine Fibroids

Uterine fibroids are benign tumors arising from smooth muscle cells of the uterus. When located near the cesarean incision, they may compress the incision or impair its blood supply, leading to poor healing and diverticulum formation. Symptoms may include menorrhagia, abdominal pain, and urinary frequency. Physicians typically recommend surgical removal of the fibroid, followed by conservative management or surgical repair depending on the status of the diverticulum.

5. Infection

Intraoperative or postoperative intrauterine infection can trigger inflammatory responses that disrupt normal wound healing, leading to abnormal fibrous tissue proliferation and scar-related diverticulum formation. Treatment may include antibiotics or antiviral medications such as cefazolin tablets, acyclovir tablets, or fluconazole tablets, as prescribed by a physician.

Maintaining good daily habits and a healthy, scientifically balanced diet, along with actively optimizing one's physical condition, can enhance treatment effectiveness when managing such conditions.

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