Gynecological laparoscopic surgery requires pneumoperitoneum(PP) with CO2 gas insufflation and Trendelenburg position. Pneumoperitoneum and Trendelenburg position may impact intraoperative respiratory mechanics in anesthetic management. This study was conducted to investigate the influence of Pneumoperitoneum and Trendelenburg position on respiratory compliance and ventilation pressure. Twenty one patients scheduled for elective gynecological laparoscopy were evaluated. The patients had no preexisting lung and heart disease or pathologic lung function. Conventional general anesthesia with thiopental sodium, fentanyl, аtracrium and isoflurane was administered. The peak inspiratory pressure, plateau pressure, and end-tidal CO2 were compared before after creation of pneumoperitoneum with an intraabdominal pressure of 15 mmH2O, then after T10, T20, T30 minutes in the 20°Trendelenburg position, and after deflation of pneumoperitoneum. The dynamic lung compliance was calculated.During of pneumoperitoneum, there were a significant increase in peak inspiratory pressure (7 cmH2O), plateau pressure(6 cmH2O), and end-tidal CO2 (6 mmH2O) while dynamic lung compliance decreased by 11 ml/cmH2O. General, the Trendelenburg position induced no significant hemodynamic and pulmonary changes.The effects of pneumoperitoneum significantly reduced dynamic lung compliance and increased peak inspiratory and plateau pressures. The Tredelenburg position did not change these parameters. The end-tidal CO2 significantly increased after pneumoperitoneum and CO2 deflation. Anesthesiologists must be aware of changes in respiratory dynamics and must be ready to respond promptly and adequately according to pneumoperitoneum with Tredelenburg position during laparoscopic surgery.

Gynecological laparoscopic surgery requires pneumoperitoneum(PP) with CO2 gas insufflation and Trendelenburg position. Pneumoperitoneum and Trendelenburg position may impact intraoperative respiratory mechanics in anesthetic management. This study was conducted to investigate the influence of Pneumoperitoneum and Trendelenburg position on respiratory compliance and ventilation pressure. Twenty one patients scheduled for elective gynecological laparoscopy were evaluated. The patients had no preexisting lung and heart disease or pathologic lung function. Conventional general anesthesia with thiopental sodium, fentanyl, аtracrium and isoflurane was administered. The peak inspiratory pressure, plateau pressure, and end-tidal CO2 were compared before after creation of pneumoperitoneum with an intraabdominal pressure of 15 mmH2O, then after T10, T20, T30 minutes in the 20°Trendelenburg position, and after deflation of pneumoperitoneum. The dynamic lung compliance was calculated.During of pneumoperitoneum, there were a significant increase in peak inspiratory pressure (7 cmH2O), plateau pressure(6 cmH2O), and end-tidal CO2 (6 mmH2O) while dynamic lung compliance decreased by 11 ml/cmH2O. General, the Trendelenburg position induced no significant hemodynamic and pulmonary changes.The effects of pneumoperitoneum significantly reduced dynamic lung compliance and increased peak inspiratory and plateau pressures. The Tredelenburg position did not change these parameters. The end-tidal CO2 significantly increased after pneumoperitoneum and CO2 deflation. Anesthesiologists must be aware of changes in respiratory dynamics and must be ready to respond promptly and adequately according to pneumoperitoneum with Tredelenburg position during laparoscopic surgery.

Background: Gynecological laparoscopic surgery requires pneumoperitoneum(PP) with CO₂ gas insufflation and Trendelenburg position. Pneumoperitoneum and Trendelenburg position may impact intraoperative respiratory mechanics in anesthetic management.The goal of this study was to evaluate the influence of Pneumoperitoneum and Trendelenburg position on respiratory mechanics and ventilation. Methods: Twenty one patients scheduled for elective gynecological laparoscopy were evaluated. The patients had no preexisting lung and heart disease or pathologic lung function. Conventional general anesthesia with thiopental sodium, fentanyl, аtracrium and isoflurane was administered. The peak inspiratory pressure, plateau pressure, and end-tidal CO₂ were compared before after creation of pneumoperitoneum with an intraabdominal pressure of 15 mmH₂O, then after PP10, PP20, PP30 minutes in the 20° Trendelenburg position, and after deflation of pneumoperitoneum. The dynamic lung compliance was calculated. Results: During of pneumoperitoneum, there were a significant increase in peak inspiratory pressure by 6 cmH₂O, plateau pressure by 5 cmH₂O, while dynamic lung compliance decreased by 11 ml/cmH₂O. General, the Trendelenburg position induced no significant hemodynamic and pulmonary changes. Conclusion The effects of pneumoperitoneum significantly reduced dynamic lung compliance and increased peak inspiratory and plateau pressures. The Tredelenburg position did not change these parameters. The end-tidal CO₂ significantly increased after pneumoperitoneum and CO₂ deflation.

Backround Peutz–Jeghers (PJ) syndrome is a rare autosomal dominant disorder characterized by a mucocutaneous pigmentationon on oral mucosa and multiple hamartomatous polyps located in the digestive tract except esophagus. PJ syndrome can be diagnosed in early childhood by a characteristic pigmentation and family history of polyposis. However, it is often diagnosed first as a polyp in the small intestine that causes obstruction and intussusception and is often treated with a bowel resection. If diagnosed in young childhood, an effective non-invasive method is to resect the polyps by tying off the blood supply to the polyps, that is the method named ischemic polypectomy, before they grow to the point of obstruction using a endoscopy. PJ syndrome is rare in Mongolia, but in severe cases, small intestine polyps are treated only surgically. Double-balloon-endoscopy (DBE) has been performed at the Mongolian- Japanese Hospital since 2023, making it possible to diagnose and treat the syndrome endoscopically. Our patient, a 15-year-old boy, had a mucocutaneous pigmentation that had been previously undiagnosed and was first diagnosed with intussusception at the age of 13. He had undergone 4 endoscopic procedures for upper and lower gastrointestinal polyps at the National Center for Maternal and Child Health successfully. In our hospital, we found endoscopically multiple hamartomatous polyps of various sizes between 1-3 cm, and a 3 mm diameter tumor that filled 3/4 of the intestinal lumen was treated by ischemic polypectomy. After the procedure, there were no early or late complications related to the procedure. The child's condition improved, the main complaints subsided, and he continues his daily life normally. However, follow-up DBE is required.

Background: Small intestinal bacterial overgrowth (SIBO) is characterized by symptoms such as malabsorption, nutrient deficiencies, bloating, and abdominal pain. It can occur independently or in association with other gastrointestinal disorders. This study aims to determine the prevalence of SIBO in patients with digestive complaints, evaluate diagnostic outcomes, and analyze the composition and types of pathogenic bacteria present in the small intestine. Materials and Methods: A single-center, cross-sectional study was conducted at the Mongolian-Japanese Hospital, enrolling a total of 46 participants. SIBO was diagnosed using the hydrogen breath test (H₂BT) with lactulose/glucose as substrates. Among the 27 diagnosed cases, 5 patients were randomly selected for microbiological analysis of small intestinal contents. Results: SIBO was detected in 58.7% of the study participants. Among the 5 patients who underwent microbiological analysis, 80% (4/5) tested positive for pathogenic bacteria. The identified pathogens included: Gram-positive bacteria: Staphylococcus aureus (S. aureus); Gram-negative bacteria: Klebsiella pneumoniae (K. pneumoniae); Antibiotic-resistant bacteria: Methicillin-resistant Staphylococcus aureus (MRSA); Fungi: Candida albicans (C. albicans). The remaining 20% (1/5) had a baseline H₂BT value exceeding twice the standard threshold despite no detected pathogens. Conclusion SIBO is highly prevalent among patients with digestive complaints and may be associated not only with bacterial infections but also fungal overgrowth. Therefore, a multidisciplinary treatment approach, including antibiotics, dietary modifications, probiotics, and antifungal therapy, is necessary. While the hydrogen breath test is an effective diagnostic tool for SIBO, standardization of diagnostic protocols is required for improved accuracy.