Case: A 38-year-old woman, gravida one, underwent cesarean delivery. She presented with irregular bleeding, and left ovary endometriotic cyst was suspected. The findings at the first visit showed a 38-mm large cyst in the bladder uterine cavity. Magnetic resonance imaging (MRI) showed a cyst with traffic with the uterus. She was diagnosed with uterine pseudo-diverticulum from a cesarean section scar, and repair was attempted under laparoscopy. Cysts were found under the bladder uterine cavity. Traffic with the uterus formed a 10-mm fistula, which was excised using an electric scalpel without leaving a fistula wall, and the muscular layer was sutured using absorbable thread. One month after surgery, thinning was not observed in the restoration site, but softening of the tissue was observed by MRI, and findings suspected of fistulas were confirmed by hysterosalpingogram (HSG). Two months later, reoperation was performed under laparoscopic and hysteroscopic assist. The periphery of the fistula was excised with a cold knife, and the muscular layer was sutured using absorbable thread. Postoperative HSG confirmed the disappearance of the diverticulum.

Conclusion: There is no established treatment method for uterine pseudo-diverticulum occurring in the cesarean section scar. However, laparoscopic repair was thought to be one of the options for patients desiring fertility. Hysteroscopic assist was important during restoration.