case_images: PMC11782943_01
case_images: Simple MRI T2-weighted sagittal section: cesarean scar pregnancy (CSP) findings (arrowhead).
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case_images: F1
case_images: A year later, a fetal sac was observed at the site of a previous incision and she was diagnosed with CSP (Figure 1).
case_images: Sagittal simple MRI T2-weighted image: cesarean scar disorder; residual myometrial thickness (RMT) area in CSDi (arrows).
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case_images: F2
case_images: Residual myometrial thickness (RMT) measured by magnetic resonance imaging performed 2 years after CSP was 6 mm (Figure 2).
case_images: Surgical port placement.
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case_images: F3
case_images: Additionally, a 35 mm skin incision was made over the cesarean section incision scar above the pubic bone, and a multichannel port was placed (Figure 3).
case_images: Hysteroscopic findings: Areas of thinning (arrows)
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case_images: F4
case_images: Therefore, we inserted a hysteroscope and directly observed the uterine lumen and identified a thinned area, although there was no scar depression or obvious atypical vessels (Figure 4).
case_images: Laparoscopic findings.. a. Identification of thinning areas using the light source of the hysteroscope (arrowhead).. b. Scarred area after serosal detachment (arrowhead).. c. Myotomy from above pubis.. d. Findings after uterine scar repair.
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case_images: F5
case_images: The thinning of the uterus was confirmed laparoscopically through the light source of the hysteroscope (Figure 5-a), and the extent of resection was determined by palpating the uterus directly through the suprapubic opening and palpating the depression at the same site. The peritoneum of vesicouterine pouch was dissected to expose the depressed thinning site (Figure 5-b), and a scissors and forceps was inserted from above the pubis to debride the thinning site into a wedge shape (Figure 5-c), followed by suturing of two layers of myometrium. The detached peritoneum was sutured closed (Figure 5-d).
case_images: Simple MRI T2-weighted sagittal section: Residual myometrial thickness (RMT) 4 months after uterine scar repair (arrow)
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case_images: F6
case_images: The RMT of the repair site on MRI performed 6 months after repair surgery was 13 mm (Figure 6).
case_images: Ultrasound: RMT area during spontaneous pregnancy (arrow)
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case_images: F7
case_images: At 8 months post-surgery, the patient became pregnant spontaneously and there was no evidence of re-thinning of the repaired scar when a transvaginal ultrasonography showed a fetal sac in the uterine body (Figure 7).