Successful surgical treatment of post-myomectomy uterine diverticulum: A case report

Abstract Background: Uterine diverticulum is classified into congenital and acquired types. The acquired type is caused by caesarean scar syndrome, which occurs after caesarean section. There are no detailed reports on diverticulum after enucleation of uterine fibroids. Most cases are treated with hysteroscopy or laparoscopy, but a management consensus is lacking. We managed a patient with a uterine diverticulum, which had formed after uterine myoma enucleation, by combining hysteroscopic and laparoscopic treatments. Case presentation: The patient was a 37-year-old Japanese woman, G1P0. A previous doctor had performed abdominal uterine myomectomy for a pedunculated subserosal uterine myoma on the right side of the posterior wall of the uterus near the internal cervical os. Menstruation had resumed postoperatively, but a small amount of dark-red bleeding persisted. MRI two months after the myomectomy revealed a diverticulum-like structure 3 cm in diameter, communicating with the uterine lumen, on the right side of the posterior wall of the uterus. Under suspicion of uterine diverticulum after uterine myoma enucleation, the patient sought treatment at our hospital approximately four months after the myomectomy. Through a flexible hysteroscope, a hole was observed, hysterosalpingography showed a fistula opening slightly above the internal cervical os in the posterior wall of the uterus and a contrast-enhanced pocket, measuring approximately 3 cm, in front of it. Uterine diverticulum following enucleation of a uterine myoma was diagnosed, and surgery was thus deemed to be necessary. The portion entering the fistula on the external cervical os side was resected employing a hysteroscope. Intra-abdominal findings included a 4-cm mass lesion on the posterior wall on the right side of the uterus. The mass was opened, and the cyst capsule was removed. A 5-mm fistula was detected and was closed with sutures. Re-suturing was not performed after dissection of the right round ligament, due to tension. The postoperative course has been good, to date, with no recurrence. Conclusion: Even after myomectomy, the occurrence site may develop a pathological condition similar to caesarean scar syndrome. Such lesions can be treated by incorporating a method similar to the that used for caesarean scar syndrome.