Balloon endometrial ablation under hysteroscopic control of septate uterus complicated by postcesarean scar defect

Use of second-generation endometrial ablation devices has largely supplanted hysteroscopic resection and rollerball ablation for treatment of menorrhagia. Pathology of the uterus may be diagnosed immediately before endometrial ablation procedure using these newer instruments, making the chosen device inappropriate and requiring a change in planned procedure. Preprocedural assessment with 1 or a combination of transvaginal ultrasound (TVS), saline-infusion sonography, and hysteroscopy is necessary to identify suitability for preferred technique. TVS is frequently used as the only investigation to assess uterine cavity, and undiagnosed or missed pathology on TVS may render chosen endometrial ablation procedure inappropriate. Previously undiagnosed septate uterus and postcesarean scar defect were diagnosed at hysteroscopy immediately before endometrial ablation, but missed by routine TVS. Balloon endometrial ablation in the septate uterus was used.