Laparoscopic isthmocele repair in a multipara with persistent abnormal uterine bleeding

Isthmocoele is an indentation at the caesarean scar caused by inadequate myometrial healing, leading to symptoms such as abnormal uterine bleeding, pelvic pain and secondary infertility. It appears as a hypoechoic collection at the scar site on transvaginal ultrasound, often with a residual myometrial thickness (RMT) <3 mm. We present a case of a woman in the late 30s, who is a multipara with three prior caesarean sections. She presented with a 2-year history of irregular prolonged intermenstrual bleeding and pelvic pain. Transvaginal sonography revealed a 1.2×1.5 cm niche with RMT of 2.8 mm. As medical therapy failed, she underwent successful laparoscopic isthmocoele repair with complete symptom resolution. A follow-up imaging confirmed restoration of normal uterine anatomy. This case highlights the efficacy of laparoscopic repair in managing symptomatic isthmocoele with thin residual myometrium.