Isthmocele: A Case Report and Review of an Increasingly Common Gynecological Hurdle

Isthmocele is emerging as an increasingly common yet troublesome diagnosis. The spectrum of potential symptoms is large, with subsequent management strategies continuing to evolve. For clinicians, having first recognized the inconsistencies in presentation, familiarity with the differing treatment options is important. We reviewed an interesting case whereby a large isthmocele with a secondary pseudocyst was diagnosed. The diagnosis was 10 years following cesarean section and three years following vaginal birth after cesarean section. Complex robotic surgical management was required owing to a large defect in close association with the urinary bladder. The authors provide an essential overview for obstetricians, gynecologists, and general clinicians to translate into practice. Discussion of the important features in the presentation and diagnosis of isthmocele is held. Particular focus is placed on management strategies and essential preoperative considerations for these complicated and variable defects.