ISTHMOCELE UTERIN : A PROPOS DE QUATRE CAS

Introduction: Isthmocele is a dehiscence at the uterine caesarean scar sitting at the anterior uterine wall opposite the isthmus. The objective of the study is to define uterine isthmoceles and its diagnostic and therapeutic modalities. Material And Methods: Through a retrospective study on a series of4 patients who presented a post caesarean isthmocel taken in charge at the gynecology department of the CHU MOHAMED VI of Oujda during the period from December 1, 2016 to December 31, 2020. Results: The patients have an average age of 40 years, multiparous at least cesareanized once.The most frequent reason for consultation was metrorrhagia. In our patients, the physical examination was unremarkable. Pelvic ultrasound and hysterosonography allowed the diagnosis of isthmocele, 2 patients were treated by laparoscopic surgery, two patients by surgical hysteroscopy. The evolution was favorable with disappearance of the symptoms and improvement of the fertility, indeed we note the occurrence of a spontaneous miscarriage then an evolutive pregnancy in the patient treated by hysteroscopy. Conclusion: Although its clinical picture is not very specific, uterine isthmocele is a new entity that should be thought of in front of a scarred uterus. There is no consensus yet, but its treatment is based on laparoscopic detection of the isthmic defect and its correction. Hysteroscopy can also be proposed as a diagnostic and therapeutic modality.