Small-bowel obstruction (SBO) during pregnancy is uncommon and can be difficult to diagnose. Therefore, the condition is associated with significant maternal and fetal mortality. We report a case of successful laparoscopic treatment of SBO in early pregnancy. A 37-year-old woman presented with diffuse abdominal pain and vomiting at 8 weeks of gestation. She had a history of abdominal surgery. Exploratory laparoscopy was performed by a gastrointestinal surgeon because SBO, and specifically strangulated ileus, was strongly suspected. On entry into the abdomen, dilated small bowel was visible in the pelvis; this was attached to the pelvic wall and twisted near the right adnexa. The small bowel initially appeared dark and congested, but after releasing the adhesions, it regained its normal color, was viable, and peristalsis was observed. Therefore, bowel resection was not required. No recurrence was observed after food ingestion, and the patient was discharged 12 days after surgery.

Objective: To identify the risk factors involved in the conversion to laparotomy during total laparoscopic hysterectomy (TLH) for benign diseases. Design: Retrospective comparative studySetting: Kaizuka Municipal Hospital for gynecologic endoscopic surgery.

Highlights Malignant peritoneal mesothelioma, particularly the sarcomatoid type, is rare and aggressive. Accurate diagnosis by ascites cytology is difficult. Histological examination such as laparoscopy aids in diagnosis. There is no clear consensus treatment for MPM and an extensive research program is needed.

The patient was a 44-year-old woman (gravida 0, para 0). We performed a total laparoscopic hysterectomy for hypermenorrhea due to submucous leiomyoma. Pneumoperitoneum was created by using 10 mmHg CO 2 . It was difficult to insert the trocar at the right lower abdominal point. End-tidal carbon dioxide (EtCO 2 ) increased gradually and was at 60 mmHg an hour after pneumoperitoneum was created. Upon investigation, a broad emphysema from the right lower jaw to the right femur was observed. This might be due to the inappropriate trocar insertion. We increased the frequency of ventilation throughout the procedure. The procedure lasted for two hours and two minutes. The emphysema improved from the right chest to the right lower abdomen at the third postoperative day and diminished at the fourth postoperative day. She was discharged at the seventh postoperative day. There are a few reports of severe ventilatory disorders because of subcutaneous emphysema due to laparoscopic surgery. Although subcutaneous emphysema often disappears spontaneously, transition to open surgery and intubation after surgery were needed in some cases. Although there is no obvious management of subcutaneous emphysema, transition to open surgery should be considered in case where EtCO 2 is increased even if we increased the frequency of ventilation.

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