Lu X, et al. - With a history of prolonged menstrual period for 5 years after her repeat cesarean delivery, a 37-year-old woman, G3P2012, presented to the hospital. Vaginal spotting and a retroverted uterus were noted in her physical examination. A 1.6×0.8-cm cesarean scar defect (CSD) was noted in the ultrasonography. The CSD showed the accumulation of mucinous blood, an extensive lack of epithelial lining with exposed vessels, and some scattered endometrial remnants with hemorrhage, along with an otherwise normal-appearing endocervical canal and endometrial cavity. A laparoscopic CSD repair was conducted. The excised cesarean scar was identified to have distorted muscles, superficial vessels, and bare stroma with focal endometrial remnants in histologic examination. The patient recovered well, and had normal menstrual period after operation. Per analysis, a bare, exudative, and hemorrhagic epithelial defect may contribute more to the symptom of abnormal uterine bleeding despite the main focus on the muscular defect of a cesarean scar (a niche or isthmocele) in previous studies.