Uterine Perforation as a Late Complication of Hysteroscopic Endometrial Ablation

A 52-year-old woman presented twice to the Emergency Department complaining of abdominal pain of unknown origin. At the second admission CT scan revealed peritoneal free fluid and an active uterine bleeding. She was then referred to our Gynecology and Obstetrics Emergency Department. Because of a progressive hemodynamic instability, she underwent an emergency exploratory laparotomy showing hemoperitoneum and a perforated uterus which was removed. The perforation was after related to a thermal damage resulting from a hysteroscopic Endometrial Ablation performed 3 months before. To the best of our knowledge this is the first reported case of late complication (3 months) of a hysteroscopic thermal ablation. We can speculate that at the time of first surgery there was no whole thickness perforation but a severe thermal necrosis that with time has progressed to the uterine serosa causing at the end the uterine perforation and the clinical situation we encountered.