J Yeungnam Med Sci.  2023 Apr;40(2):202-206. 10.12701/jyms.2022.00115.

Laparoscopic excision and repair of a cesarean scar pregnancy in a woman with uterine didelphys: a case report

• Park SE
• Ryu JE
• Jang TK

• KMID: 2541948
• DOI: http://doi.org/10.12701/jyms.2022.00115

Abstract

Cesarean scar pregnancy (CSP) is a rare complication that occurs in less than 1% of ectopic pregnancies, and uterine didelphys is one of the rarest uterine forms. We report a successful laparoscopic excision and repair of CSP in a woman with uterine didelphys and a double vagina. A 34-year-old gravida one, para one woman with a history of low transverse cesarean section presented to our hospital with a suspected CSP. She was confirmed to have uterine didelphys with a double vagina during an infertility examination 7 years earlier. Magnetic resonance imaging showed a 2.5-cm gestational sac-like cystic lesion in the lower segment of the right uterus at the cesarean scar. We decided to perform a laparoscopic approach after informing the patient of the surgical procedure. The lower segment of the previous cesarean site was excised with monopolar diathermy to minimize bleeding. We identified the gestational sac in the lower segment of the right uterus, which was evacuated using spoon forceps. The myometrium and serosa of the uterus were sutured layer-by-layer using synthetic absorbable sutures. No remnant gestational tissue was visible on follow-up ultrasonography one month after the surgery. This laparoscopic approach to CSP in a woman with uterine didelphys is an effective and safe method of treatment. In women with uterine anomalies, it is important to confirm the exact location of the gestational sac by preoperative imaging for successful surgery.

Keyword

Cesarean section; Laparoscopy; Uterine disease

Figure

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  Fig. 1. A gestational sac and intramural myoma on magnetic resonance imaging (T2, sagittal plane). It shows a 41-mm intramural myoma (arrow) at the uterine anterior wall and a 25-mm gestational sac (arrowhead) on the right lower uterine segment.

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  Fig. 2. Focus of the ectopic pregnancy (arrow) protruding outwards from the uterine lower segment.

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  Fig. 3. Products of conception (arrow) on the lower anterior myometrium.

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  Fig. 4. Bifurcated endocervical canals. Lt, left; Rt, right.

Reference

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