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Spontaneous pneumediastinum (Hamman’s syndrome) is a rare pathology defined as the presence of free air in the mediastinum with subcutaneous emphysema without trauma or medical problem. It is also a rare complication of labour and delivery and it usually occurs in the second stage of labour. A twenty-six-year-old primigravida presented to our hospital at 39 weeks and 6 days in spontaneous labour. Two hours following the delivery the patient developed neck tightness and chest tenderness with palpation. Chest X-ray and CT scan revealed pneumomediastinum extending into the soft tissue of the neck. A conservative management was performed. Spontaneous pneumomediastinum is a rare condition with a reported incidence of less than 1:44000 and in the setting of pregnancy or labor 1:100000. Regarding pregnancy, the valsalva maneuvers produced in the second stage of labor has been implicated in the development of spontaneous pneumomediastinum. Chest X-ray (posteroanterior and lateral view) is the most important test to confirm the diagnosis. The Hamman’s syndrome has usually a benign course and the management in often conservative. A timely diagnosis of Hamman’s syndrome is necessary for patient safety and correct management, but most cases have a self-limiting course.

Hysteroscopic sterilization with Essure ® microinsert is a method of female permanent contraception. Complications of the procedure are malpositioning, unintended pregnancy, abnormal uterine bleeding, and chronic pelvic pain. We report the case of a 44-year-old patient presented to our hospital for chronic pelvic pain and abnormal uterine bleeding. She had 5 years before a hysteroscopic placement of an Essure ® device. At hysteroscopy, both devices were removed and a laparoscopic bilateral salpingectomy was performed. The patient reported resolution of chronic pelvic pain and of abnormal uterine bleeding following surgical procedures. Pelvic pain is the main symptom described after Essure ® insertion with an incidence of 4.2% regarding persistent pain. The patients should be informed about the risks and benefits of hysteroscopic and laparoscopic sterilization procedures.

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