Laparoscopic surgery has made tremendous progress because of its many advantages, including less postoperative pain, an earlier return to normal activity, a shorter hospital stay and better cosmetic results. These advantages make laparoscopic surgery an extremely useful procedure for patients with acute abdomen. Certainly, emergency laparoscopy can provide useful informations on the pathogenesis, degree of bleeding and inflammation presented. This informations can then be used to decide whether open surgery can be indicated. In fact, emergency laparoscopy has enabled unnecessary laparotomies to be avoided in some patients with intra-abdominal bleeding or inflammatory diseases. Presently, the authors believe that the indications and techniques for emergency laparoscopy with or without laparoscopic surgery are the same in Japan and in western countries. However, the adoption of a laparoscopic approach as the standard procedure for patients with acute abdomen has been slightly slower in Japan than that of western countries. This trend probably results from the lack of facilities and trained staff in individual hospitals or the government-controlled Japanese health insurance system. Nevertheless, patients have the right to receive the best care available, and unnecessary or excessive surgery must be avoided whenever possible. In the future, emergency laparoscopy and laparoscopic surgery should be used more often. By increasing the number of trained young surgeons and the availability of instruments the benefits of laparoscopic surgery can be made available to the patients with acute abdomen. Furthermore, the adoption of emergency laparoscopy as a standard procedure should contribute to the reduction of medical fees.

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A case of strangulation of the small intestine through the drain hole is reported. A 71-year-old woman was diagnosed as having diffuse peritonitis due to perforation of a duodenal ulcer and emergency peritoneal drainage was performed. At 12 days postoperatively, 5 hours after a drain had been removed, strangulation of the small intestine through the drain hole was found. We had to perform resection of the small intestine and close the drain hole. To our knowlege, this is the fifth case of strangulation of the small intestine through the drain hole. Though numerous complications are associated with drainage, appropriate consideration of drain management for various patients is important.

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