MRI appearance of the low transverse incision after caesarean section in a symptomatic woman

It has been observed that a history of a caesarean section could be related to conseguent abnormal uterine bleeding. Almost all the authors who have studied this clinical problem utilized echografic techniques to understand the correlation, if any, between this symptom and the caesarean section scar. In the present study, we report a case of a 36-year-old woman who was referred to our Department of Obstetrics and Gynecology because of metrorrhagia in absence of gynaecological pathologies. The woman had had a single caesarean section 6 years prior. The transvaginal sonography (TVS) showed the uterus and adnexa to be anatomically normal. Experimentally, the woman underwent a magnetic resonance imaging (MRI) of the pelvis in order to obtain a better visualization of the caesarean section scar. The MR study demonstrated that the endometrial and myometrial layers were interrupted by the caesarean section scar, and blood accumulation was found in the endometrial cavity. The patient underwent endometrial ablation and remained free of symptoms after 4 months of follow-up. The case reported clearly shows that MRI allows a good visualization of the caesarean section scar and the disruption of all uterine layers (not previously visualized using TVS). In selected cases, MR images could help the clinicians in differential diagnosis of abnormal uterine bleeding in women with one or more previous caesarean delivery.