Carbon dioxide (CO2) insufflation is now essential for most endoscopic surgeries, such as abdominal, pelvic, and neck endoscopic surgery. It is not uncommon for CO2 leaks to occur unintentionally into subcutaneous tissue, later diffusing into a patient's bloodstream and resulting in hypercarbia. Regardless of the etiology of subcutaneous emphysema, a similar clinical management is required. Herein, we report on a case of tension subcutaneous emphysema and subsequent fatal ventilatory failure due to massive subcutaneous emphysema during laparoscopy. A timely blowhole incision is an effective intervention in an emergent setting like this case, although the patient had endotracheal intubation.