CASE REPORT article
Front. Med.
Sec. Obstetrics and Gynecology
Volume 12 - 2025 | doi: 10.3389/fmed.2025.1632322
This article is part of the Research Topic25 Years of 21st Century MedicineView all 17 articles
Hysteroscopic surgery for the treatment of intramural fibroids in the scar area of cesarean section：A case report and literature review
Provisionally accepted
- 1964th Hospital of PLA, Changchun, China
- 2The Affiliated Hospital of Changchun University of Traditional Chinese Medicine, Changchun, Jilin Province, China
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Background: Uterine fibroids located at cesarean section scar sites are rare and differ clinically from conventional fibroids, frequently causing abnormal uterine bleeding and infertility. Traditional surgical approaches (laparotomy, laparoscopy, or vaginal surgery) necessitate incision of the scar site, resulting in significant tissue damage. We present a successful case of hysteroscopic resection for such fibroids, demonstrating its minimally invasive advantages.Case summary: A 49-year-old multiparous woman with a history of cesarean delivery presented with a 2-year history of menorrhagia and prolonged menstrual cycles, exacerbated over the preceding month. Gynecological ultrasound revealed heterogeneous hypoechogenicity within the cervical canal, with a size of approximately 5.3×3.5×3.3cm. Physical examination showed an enlarged uterus, approximately the size of 11×8×7cm. Hematologic workup showed the hemoglobin (HGB) to be 65g/L. Based on these examination results, a clinical diagnosis of "uterine fibroids, secondary anemia" was conducted. Hysteroscopy examination showed that the base of the uterine fibroid was attached to the scar site of the original cesarean section, without a pedicle, and the main body of the fibroid remained in the cervical canal. Intraoperative definitive diagnosis: intramural fibroids at the scar site of the uterus. So, a hysteroscopic approach with bipolar resectoscope was used to remove the intramural fibroids in the scar area of the uterus. The procedure consumed 22000 ml of fluid distension media (0.9% NaCl) and lasted for 1 hour and 45 minutes.The postoperative pathological diagnosis was uterine leiomyoma, consistent with the preoperative diagnosis. Follow up was conducted three months after surgery, and gynecological ultrasound examination showed complete removal of uterine fibroids.This case confirmed that hysteroscopic resection of cesarean scar intramural fibroids is a feasible, safe, and minimally invasive approach.
Keywords: experienced surgical team, Hysteroscopy, rigorous fluid monitoring, scar site of cesarean section, Technical challenges, Uterine fibroids
Received: 21 May 2025; Accepted: 13 Aug 2025.
Copyright: © 2025 Wu, Liu, Zhang, Ma, Yao and Wang. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence:
Tianming Yao, 964th Hospital of PLA, Changchun, China
Li Wang, 964th Hospital of PLA, Changchun, China
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