Diagnosis of caesarean section scar niche causing chronic pe
The common causes of chronic pelvic pain include chronic pelvic inflammatory disease, endometriosis, inflammatory bowel disease, etc.

Cesarean scar defect is recently recognized as a cause of chronic pelvic pain. A 33-year-old para 2 with previous 2 cesarean sections, whose last childbirth was 18 months back consulted for rectal pain of 4 months duration.

She was treated with progesterone with a provisional diagnosis of endometriosis without much relief. She developed congestive dysmenorrhea and dyspareunia after her last child's birth. Her clinical examination revealed a retroverted uterus with left fornical tenderness. USG evaluation confirmed the clinical findings and evaluation of uterine scar was not undertaken as the possibility of cesarean scar defect (CSD) was not thought of as a cause for chronic pelvic pain.

MRI pelvis reported semicircular myometrial defect at LSCS scar site and this was confirmed by hystero-laparoscopy and she was counseled to undergo repair of CSD. The case illustrated the clinical picture and diagnosis of CSD as a cause for chronic pelvic pain.

International Journal of Reproduction, Contraception, Obstetrics, and Gynecology
Source: https://dx.doi.org/10.18203/2320-1770.ijrcog20213500