We introduce MARL-MambaContour, the first contour-based medical image segmentation framework based on Multi-Agent Reinforcement Learning (MARL). Our approach reframes segmentation as a multi-agent cooperation task focused on generate topologically consistent object-level contours, addressing the limitations of traditional pixel-based methods which could lack topological constraints and holistic structural awareness of anatomical regions. Each contour point is modeled as an autonomous agent that iteratively adjusts its position to align precisely with the target boundary, enabling adaptation to blurred edges and intricate morphologies common in medical images. This iterative adjustment process is optimized by a contour-specific Soft Actor-Critic (SAC) algorithm, further enhanced with the Entropy Regularization Adjustment Mechanism (ERAM) which dynamically balance agent exploration with contour smoothness. Furthermore, the framework incorporates a Mamba-based policy network featuring a novel Bidirectional Cross-attention Hidden-state Fusion Mechanism (BCHFM). This mechanism mitigates potential memory confusion limitations associated with long-range modeling in state space models, thereby facilitating more accurate inter-agent information exchange and informed decision-making. Extensive experiments on five diverse medical imaging datasets demonstrate the state-of-the-art performance of MARL-MambaContour, highlighting its potential as an accurate and robust clinical application.