Case Presentation: A 32-year-old pregnant woman in her 21st week of gestation, G3P2A0, with both deliveries by C-section, presented with a diagnosis of fetal demise confirmed by US. She underwent medical termination with a high dose of misoprostol tablets. At a private hospital, she complained of worsening lower abdominal pain and tenderness. The transabdominal US revealed a bulky uterus with a heterogeneous mass composed of macerated fetal parts and placenta emerging through the left lower uterine segment near the scar site. To confirm the diagnosis, MRI showed a large, non-enhancing structure measuring 90 × 90 mm, communicating with the uterine cavity through the C-section scar, supporting the diagnosis of uterine dehiscence and hematoma formation. Emergency laparotomy confirmed the diagnosis of uterine dehiscence with extrusion of macerated fetal tissue through the defect. Surgical repair was performed, and the postoperative period was uneventful.

Conclusion: This case reinforces the cautious use of uterotonic drugs, such as misoprostol, in patients with repeated C-sections. MRI was a valuable adjunct in confirming the diagnosis when US findings were inconclusive. A multidisciplinary approach, utilizing judicious imaging tools, especially MRI in complex cases, and timely intervention, is crucial for preventing life-threatening outcomes and preserving patient fertility.

Case Report: A 31-year-old woman with a history of previous 2 cesarean sections presented with a chronic on-and-off pus discharge from the transverse scar. She received multiple courses of antibiotics previously. Pus culture for microbiological analysis was found to be negative for organisms, including Mycobacteria species. Magnetic resonance imaging with contrast revealed a likely vascular/ inflammatory collection along the rectus sheath, indicating a utero-vesico-cutaneous sinus tract. A methylene blue-stained tract facilitated its complete removal. A final histopathological staining concluded the possibility of a suture granuloma.

Discussion: Tuberculosis is known to present with similar symptoms, especially years after abdominal surgery, and needs a thorough preoperative exclusion. In our case, the presence of a nontubercular granulomatous inflammation with a suture seen along the tract confirmed the diagnosis. The patient did not report any recurrence of symptoms during the six-month follow-up.

Conclusion: Imaging the entire tract and performing complete excision, followed by judicious use of subcutaneous drains and closure with delayed absorbable monofilament sutures, are preferable to avoid recurrence. This case emphasizes the importance of timely diagnosis in improving the quality of life of the affected patients.