Uterine and Sigmoid Colon Perforation Following Hysteroscopy-Guided Microwave Endometrial Ablation (MEA) in a Patient With a Bicornuate Uterus and Multiple Myomas: A Case Report

In Japan, the microwave endometrial ablation system (MEA, Microsulis PLC, Waterlooville, UK) is the most widely used device for endometrial ablation and is considered a minimally invasive, uterus-preserving treatment for menorrhagia. Although MEA is generally safe, uterine and/or bowel perforation can occur as a rare but serious complication. We report a case of uterine and sigmoid colon perforations following hysteroscopy-guided MEA in a patient with a bicornuate uterus, endometriosis, and multiple uterine myomas. To our knowledge, this is the first reported case of simultaneous uterine and bowel perforation due to thermal injury after MEA in a patient with a bicornuate uterus. Careful preoperative evaluation and appropriate postoperative counseling are crucial, particularly in patients with uterine anomalies or suspected intra-abdominal adhesions.