Rare complications of cesarean scar
A 32-year-old gravida 3, para 2 with a previous lower segment cesarean section (LSCS) 3 years back had an elective LSCS at 40 weeks. She had no existing medical or antenatal problems. LSCS was done. A healthy baby was delivered, but she had severe pain in the lower abdomen for next 4 days along with spotting. TAS showed 10.2 × 5.3 × 6.2 cm hypoechoic collection along the anterior aspect of uterus. However, limited evaluation was possible due to abdominal tenderness and pain on probe compression. TVS was performed and it showed a large heterogeneously hypoechoic collection anterior to the uterus, which was communicating with the endometrial cavity with myometrial defect in the region of the CS []. MRI was done to confirm CSD. MRI showed a 10.5 × 8 × 6.6 cm hematoma appearing as heterogeneously hyperintense on T1-weighted image (T1WI) and T2-weighted image (T2WI), anterior to uterus [Figure and ]. This hematoma was communicating with the endometrial cavity through a defect in the anterior wall of myometrium in the region of CS. Mild free fluid was seen in the peritoneal cavity [Figures and ]. The patient was started on antibiotics and managed conservatively. Under USG guidance, a 10-French pigtail catheter was inserted into the collection which yielded thick hemorrhagic blood. Regular flushing and reaspiration was done. The hematoma resolved and the patient's clinical condition improved with antibiotics. On follow-up after 6 months, there was almost complete resolution of the hematoma and the CS had healed.