Septic shock during pregnancy is very rare but has high mortality. We report a case of septic shock in a pregnant woman with ileus, showing that severe ileus in a pregnant woman could be attributed to life-threatening septic shock and that we should give special attention to a nosocomial infection.

Abstract：Anti-N-methyl-D-aspartate (NMDA)-receptor encephalitis is a paraneoplastic encephalitide that causes various symptoms. It occurs especially in young women, with about 60% of cases being associated with ovarian teratoma.We report two cases of emergency laparoscopic surgeries for anti-NMDA-receptor encephalitis associated with ovarian teratoma.Case 1: A 17-year-old woman had headache, fever and vomiting. A week later, she also had abnormal behavior and hallucination and entered hospital. CT scan detected left ovarian teratoma. As anti-NMDA-receptor encephalitis was suspected, she underwent laparoscopic left ovarian cystectomy. She needed post-operative respirator management for 2.5 months. Although discharged after 4.5 months, she was sent to a psychiatrist after 7 months because of domestic violence. The pathological diagnosis was an immature teratoma, but there is no sign of recurrence.Case 2: A 26-year-old woman had fever, headache and fatigue. A few days later, she also had memory disorder and entered hospital. CT scan detected right ovarian teratoma. As anti-NMDA-receptor encephalitis was suspected, she underwent single incision laparoscopic right salpingo-oophorectomy. She needed post-operative respirator management for 9 months and left hospital after 1 year. The pathological diagnosis was a mature teratoma.Antibodies against NMDA-receptor were positive in both cerebrospinal fluids.Early diagnosis and surgery are important for quick recovery of anti-NMDA-receptor encephalitis associated with ovarian teratoma. Even so, patients don't necessarily recover quickly without aftereffects. We should review operative methods, because the patient is young and cannot agree and immature teratoma prevalence is high. Whether a tumor is benign or malignant, it is important to prevent leakage of tumor contents whenever possible.

Endometriosis may occur in various parts of the body, but it rarely forms a cystic mass outside of the ovary. We had a case of extra-ovarian endometrial cyst that underwent laparoscopic surgery.Case: A 38 year-old, gravida 1, para 1 woman experienced acute abdominal pain and was taken to the receiving hospital by ambulance. She was hospitalized for 6 days on diagnosis of a ruptured endometrial cyst. After discharge she was referred to our hospital. She underwent abdominal myomectomy 4 years prior and cesarean section 2 years before the current episode. Ultrasonography and magnetic resonance imaging (MRI) scan detected an endometrial cyst of 10 cm in size and normal bilateral ovaries. The origin of the mass was not clear. A slight elevation in tumor markers CA125 (77.6 U/mL) and CA19-9 (47.2 U/mL) was observed. She underwent laparoscopic surgery after one month. At laparoscopy, a fist-sized cyst was detected in the ventral portion of the uterus and chocolate-like, dark brown fluid pooled in the abdominal cavity. The cyst adhered extensively to the surrounding tissue; thus, we peeled off the adhesions and removed the cyst. The cyst was attached to the right uterosacral ligament. The uterus and both ovaries were normal and showed no anatomical connection with the cyst. The pathological diagnosis was endometrial cyst, but there was no evidence to suggest any involvement of the ovary. Her postoperative course was uneventful and she was discharged at postoperative day 3. There has been no sign of recurrence for 5 years.

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