Thermal Injury and Cecal Perforation Following Ultrasound-guided Percutaneous Microwave Ablation of a Uterine Fibroid: A Case Report and Literature Review

Abstract Microwave ablation (MWA) is a minimally invasive, uterine-sparing treatment option for symptomatic uterine fibroids and has gained increasing favor among patients and clinicians due to its efficacy and low complication rates. We report the case of a 40-year-old woman with persistent menorrhagia refractory to pharmacologic management. The patient underwent transabdominal MWA. Despite initial postprocedural stability, she developed severe abdominal pain 24 h later. Emergent magnetic resonance imaging revealed free intraperitoneal fluid, and exploratory laparotomy confirmed a thermally perforated, midline-displaced cecum. This case underscores the critical importance of preprocedural recognition of anatomical variations – such as a mobile cecum – and highlights the need for comprehensive procedural planning, including consideration of antenna trajectory, treatment duration, power settings, and perfusion characteristics, to ensure safe and effective MWA.