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Severe delayed postpartum hemorrhage due to a neglected uterine diverticulum: a case report.

BACKGROUND
Symptomatic uterine diverticula are rare and, to our knowledge, have never been reported as a cause of postpartum hemorrhage.


CASE
A 35-year-old woman presented with severe vaginal bleeding on the 47th day after a cesarean section. She had received endometrial curettage due to postpartum hemorrhage a few days earlier in another local hospital. Transvaginal ultrasound revealed a thickened heteroechoic endometrium and an isolated isthmic heteroechoic cystic lesion. Repeat endometriaI curettage was performed initially. However, recurrent vaginal bleeding and hypovolemic shock occurred 2 days later. Active bleeding from a debris-full diverticulum in the lateral wall of the uterine isthmus was found during an emergent hysterotomy. The myometrium was sutured to obliterate the diverticulum. The follow-up course was uneventful.


CONCLUSION
Uterine diverticula may present as isolated isthmic heteroechoic cystic lesions and may be overlooked as a cause of severe delayed postpartum hemorrhage.