Operative hysteroscopy
Histimocele And Hysteroscopic Hysteroplasty
The isthmocele consists of a sacciform dilatation at the level of the cervical canal at the previous caesarean section scar.
Simply put, it is a kind of hernia, a bowl where menstrual blood collects, the stagnation of which causes inflammation and sometimes pelvic pain.
The still blood is then eliminated over the next few days in the form of dark, foul-smelling persistent ooze.
Symptomatology
The woman suffering from this condition complains of dark bleeding after regular menstruation that lasts up to several days, of a foul odour, and sometimes pelvic pain due to the concomitant inflammation. She may also have difficulty conceiving because the isthmocele may interfere with the migration of sperm through the cervical canal and thus delay fertilisation.
Diagnosis
The suspicion is raised at the simple examination, evaluating the symptoms reported by the patient. A transvaginal ultrasound scan shows a roundish, ectopic sac of varying size depending on the size of the isthmus at the level of the cervical canal.
Hysteroscopy, an essential examination for the diagnosis, confirms the presence of the isthmocele, its location, size, the presence of concomitant inflammation, the discharge of dark blood and provides the absolute indication for repair by operative hysteroscopy.
Therapy: Hysteroscopic Hysteroplasty
Under general anaesthesia, the resector is introduced, a wash is established to eliminate residual blood and obtain excellent visibility of the surgical field, and with a thermal oblique loop all the anterior and lateral edges of the isthmus are resected in a clockwise or counterclockwise direction until it is 'flattened' completely, thus considerably reducing the depth of the fovea where the menstrual blood collected and favouring its complete outflow during the following menstruation. The result is guaranteed in more than 80% of cases.
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