近澤 研郎

We present a case of laparoscopic bladder injury, a single case in a total of 127 total laparoscopic hysterectomies (TLHs). The incidence of laparoscopic bladder injury is reported to be 0.2- 2.0% of TLHs. The injury was noted following the patient's complaint of urinary incontinence 14 days after undergoing TLH. The vesicovaginal fistula was diagnosed by cystoscopy. A retrospective review of the moving images of the surgical operation revealed that we cut the bladder by monopolar diathermy in poor visibility due to smoke. Secondary surgical repair was performed via laparoscopy. Final closure of the fistula was achieved abdominally since the laparoscopic approach was unsuccessful. The American Association of Gynecologic Laparoscopists (AAGL) recommends routine cystoscopy after TLH because only 25-50% of urinary tract injuries caused during TLH are recognized during the procedure.

Posterior reversible encephalopathy syndrome, if it occurs in late pregnancy, requires pregnancy termination. Here, we report a woman without a discernable underlying condition who developed neurological deficits at 14 weeks of pregnancy. Magnetic resonance imaging demonstrated an occipitoparietal brain lesion suggestive of posterior reversible encephalopathy syndrome. Neurological symptoms ameliorated spontaneously and she continued her pregnancy to term. A decision to terminate pregnancy based on only neurological and magnetic resonance imaging findings should be avoided.