Iatrogenic Uterine Perforation with Kronner Uterine Manipulator

Iatrogenic uterine perforation due to initial overinflation of the Kronner uterine manipulator balloon through the balloon port is previously unreported. A 37-year-old multipara with a 1 year history of dysmenorrhea, menorrhagia, and post coital spotting desired permanent sterilization following 9 years of copper intrauterine device (IUD) use. At the onset of the procedure a Kronner uterine manipulator was placed and inadvertently inflated with 30 ml instead of 10 ml of air. Upon insertion of the laparoscope for laparoscopic tubal sterilization a 1 cm diameter perforation of the uterine fundus was noted. Hemostasis was achieved by bipolar cauterization, following which the intended procedure was completed. We believe that the iatrogenic uterine perforation was caused by overinflation of the intrauterine balloon of the Kronner uterine manipulator, in a uterus whose fundus was already weakened from 9 years of IUD use. While intrauterine balloons placed for gynecologic or obstetrical hemostasis may be inflated from 30 to 300 ml, overinflation of a uterine manipulator balloon in nonhemorrhagic situations can cause uterine perforation.