Laparoscopic repair of iatrogenic diaphragmatic hernia following radiofrequency ablation for hepatocellular carcinoma

Abstract We describe the case of a patient with a diaphragmatic hernia associated with radiofrequency ablation for hepatocellular carcinoma who was successfully treated by laparoscopic surgery. A 62-year-old man with a long history of hepatitis C-induced liver cirrhosis was admitted to our institution because of recurrent postprandial periumbilical pain. Eight years earlier, he had undergone radiofrequency ablation for hepatocellular carcinoma at hepatic segment VIII. Computed tomography, gastrografin enema examination revealed transverse colon obstruction because of a diaphragmatic hernia. We diagnosed diaphragmatic hernia associated with the prior radiofrequency ablation treatment. The patient underwent laparoscopic repair of the diaphragmatic hernia. Though the patient experienced the recurrence once, relaparoscopic treatment has improved the patient's conditions. Thus, diaphragmatic hernia can develop as a complication of radiofrequency ablation treatment. A laparoscopic approach is safe, feasible, and minimally invasive, even in patients with cirrhosis who develop iatrogenic diaphragmatic hernia as a complication of radiofrequency ablation treatment.

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Laparoscopic repair of diaphragmatic hernia after radiofrequency ablation for hepatocellular carcinoma: Case report

International Journal of Surgery Case Reports ◽

10.1016/j.ijscr.2021.105728 ◽

2021 ◽

Vol 81 ◽

pp. 105728

Author(s):

Hokuto Ushijima ◽

Jin-ichi Hida ◽

Yoshinori Yane ◽

Hiroaki Kato ◽

Kazuki Ueda ◽

...

Keyword(s):

Hepatocellular Carcinoma ◽

Case Report ◽

Radiofrequency Ablation ◽

Diaphragmatic Hernia ◽

Laparoscopic Repair

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Successful surgical rescue of delayed onset diaphragmatic hernia following radiofrequency ablation using a thoracoscopic approach for hepatocellular carcinoma: a case report

Surgical Case Reports ◽

10.1186/s40792-021-01213-8 ◽

2021 ◽

Vol 7 (1) ◽

Author(s):

Atsushi Morito ◽

Shigeki Nakagawa ◽

Katsunori Imai ◽

Norio Uemura ◽

Hirohisa Okabe ◽

...

Keyword(s):

Hepatocellular Carcinoma ◽

Small Intestine ◽

Radiofrequency Ablation ◽

Diaphragmatic Hernia ◽

Invasive Treatment ◽

Thoracoscopic Approach ◽

Case Presentation ◽

Medial Segment ◽

Liver Surface ◽

The Right

Abstract Background Radiofrequency ablation (RFA) is widely used as a minimally invasive treatment for hepatocellular carcinoma (HCC). RFA has a low risk of complications, especially compared with liver resection. Nevertheless, various complications have been reported after RFA for HCC; however, diaphragmatic hernia (DH) is extremely rare. Case presentation A 78-year-old man underwent thoracoscopic RFA for HCC located at the medial segment adjacent to the diaphragm approximately 7 years before being transported to the emergency department due complaints of nausea and abdominal pain. Computed tomography revealed a prolapsed small intestine through a defect in the right diaphragm, and emergency surgery was performed. The cause of diaphragmatic hernia was the scar of RFA. We confirmed that the small intestine had prolapsed into the right diaphragm, and we resected the necrotic small intestine and repaired the right diaphragm. Herein, we report a case of ileal strangulation due to diaphragmatic hernia after thoracoscopic RFA. Conclusions Care should be taken when performing thoracoscopic RFA, especially for tumors located on the liver surface adjacent to the diaphragm. Patients should be carefully followed up for possible DH, even after a long postoperative interval.

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