Key Surgical Points

1. Explore the uterine cavity and cervical structure before electroresection, and delineate the resection scope. 2. Irrigate the accumulated blood and mucus inside the diverticulum to fully visualize the scar diverticulum during electroresection. 3. Perform thin, limited electroresection to avoid excessive deep cutting.Brief Medical HistoryPatient Profile Female, 38 years old, admitted with "intermenstrual vaginal bleeding for over 7 years after cesarean section".Clinical ManifestationsPresent Illness The patient had regular menstruation previously, with last menstrual period on May 28, 2025. She underwent cesarean section at another hospital more than 7 years ago, after which she developed intermenstrual spotting with scant brown discharge persisting for over 20 days. She did not receive formal treatment at that time. She visited our hospital on November 26, 2024. Transvaginal ultrasound revealed an anechoic area in the lower uterine segment suggestive of uterine scar diverticulum. Oral norethisterone was administered for symptomatic relief, and her symptoms improved temporarily but relapsed after drug discontinuation. She was admitted for surgical intervention with a tentative diagnosis of abnormal uterine bleeding secondary to suspected uterine scar diverticulum. Marital and Obstetric History Reproductive-aged female, Gravida 3 Para 2 Abortion 1: two cesarean deliveries and one induced abortion. Past Medical History No history of hypertension, diabetes, blood transfusion or drug allergy. Physical Examination Vital signs: Temperature 36.0℃, Pulse 70 beats/min, Respiration 20 breaths/min, Blood Pressure 126/77 mmHg. Alert and oriented; no obvious abnormalities on cardiopulmonary auscultation. A 12 cm long transverse old surgical scar is visible on the lower abdomen. Gynecological Examination Normal vulvar development; patent vagina with a small amount of white vaginal discharge. Smooth cervix of normal size; anteverted uterus with good mobility, no tenderness or rebound tenderness. No palpable masses or tenderness in bilateral adnexal regions. Auxiliary Examinations Transvaginal color Doppler ultrasound performed on June 23, 2025: A wedge-shaped anechoic area measuring approximately 8 mm × 8 mm is detected at the lower anterior uterine wall (above the internal cervical os), communicating with the uterine cavity. The distance from the anterior edge of the lesion to the anterior serous layer of the uterus is about 3 mm. Findings consistent with uterine scar defect. Diagnosis 1. Abnormal uterine bleeding – Suspected uterine scar diverticulum Surgical Procedure Hysteroscopic repair of uterine scar diverticulum The patient has no future fertility requirements; a uterine septum-like deformity identified intraoperatively was left untreated.Surgeon ProfileZhong JianyeAssociate Chief Physician, Academic Leader of the Department of Obstetrics and Gynecology, Huidong Second People's Hospital - Standing Committee Member, Huizhou Obstetrics and Gynecology Physicians Branch - Member, Huizhou Reproductive Medicine Branch - Standing Committee Member, Huidong Obstetrics and Gynecology Branch He leads the obstetrics and gynecology team of Huidong Second People's Hospital to carry out a full range of surgeries, including hysteroscopy, laparoscopy, gasless single-port laparoscopy, transvaginal procedures such as hysterectomy, myomectomy, vaginal obliteration/partial obliteration, and cervical cerclage for cervical insufficiency.

Editor-in-charge: Qinghuan Reviewer: Ma Ye