The differential diagnosis of intermenstrual bleeding includes structural lesions of the endometrium and cervix.
Discrete diverticuli were noted in the endocervical canals of three women presenting with histories of multiple cesareans and chief complaints of intermenstrual bleeding. On ultrasound, diverticuli were diagnosed as cavities filled with heterogeneous material consistent with blood. In one case, the diverticulum was also visualized on hysterosalpingogram. Hysterectomy specimens in two cases showed diverticuli lined with fibrous tissue in previous uterine scars; in one case, this also contained endometrium.
Uterine scar diverticuli may cause intermenstrual bleeding in women with previous cesareans. When performing ultrasound in this clinical setting, physicians should look for these defects.
Department of Obstetrics and Gynecology and Division of Reproductive Endocrinology and Infertility, University of Iowa Hospitals and Clinics, Iowa City, Iowa.
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Received April 24, 1998. Received in revised form June 15, 1998. Accepted July 2, 1998.