Acute Intestinal Necrosis due to Diaphragmatic Hernia after Radiofrequency Ablation for Hepatocellular Carcinoma: A Case Report and Literature Review

Abstract Background: Radiofrequency ablation is widely used as an effective and minimally invasive treatment of hepatocellular carcinoma. The complications of radiofrequency ablation are mainly associated with needle damage or local thermal damage, while the reports of long-term complications of radiofrequency ablation are relatively rare.Case Report: This report presents a case of hepatocellular carcinoma with diaphragmatic hernia after radiofrequency ablation. A 60-year-old male came to the hospital with sudden abdominal pain for one day, who had received radiofrequency ablation and transcatheter arterial chemoembolization treatment for hepatocellular carcinoma located in segment 8 as an initial treatment 52 months ago. Computed tomography showed the right diaphragmatic hernia, small intestine intruding into the chest with intestinal obstruction. The patient underwent an emergency diaphragmatic repair with bowel resection and was successfully discharged 1 week after the operation.Conclusion: Diaphragmatic hernia is a long-term complication of radiofrequency ablation. Surgical treatment is recommended as the first choice when conditions permitted.

Download Full-text

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.

Download Full-text

Intestinal Necrosis Caused by Incarcerated Diaphragmatic Hernia Following Percutaneous Radiofrequency Ablation Therapy for Hepatocellular Carcinoma

Nihon Gekakei Rengo Gakkaishi (Journal of Japanese College of Surgeons) ◽

10.4030/jjcs.41.121 ◽

2016 ◽

Vol 41 (1) ◽

pp. 121-126

Author(s):

Tsuyoshi Hata ◽

Masaki Kashiwazaki ◽

Masahiko Kubo ◽

Kiminori Yanagisawa ◽

Hirofumi Miki ◽

...

Keyword(s):

Hepatocellular Carcinoma ◽

Radiofrequency Ablation ◽

Diaphragmatic Hernia ◽

Percutaneous Radiofrequency Ablation ◽

Ablation Therapy ◽

Intestinal Necrosis ◽

Radiofrequency Ablation Therapy

Download Full-text

Laparoscopic Repair of a Diaphragmatic Hernia Associated with Radiofrequency Ablation for Hepatocellular Carcinoma: Lessons from a Case and the Review of the Literature

International Surgery ◽

10.9738/intsurg-d-14-00025.1 ◽

2014 ◽

Vol 99 (4) ◽

pp. 384-390 ◽

Cited By ~ 3

Author(s):

Ryohei Nomura ◽

Hiromi Tokumura ◽

Makoto Furihata

Keyword(s):

Computed Tomography ◽

Hepatocellular Carcinoma ◽

Radiofrequency Ablation ◽

Diaphragmatic Hernia ◽

Laparoscopic Repair ◽

Laparoscopic Approach ◽

Review Of The Literature ◽

Gastrografin Enema ◽

History Of ◽

Segment Viii

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.

Download Full-text

Sequential transarterial chemoembolization and early radiofrequency ablation improves clinical outcomes for early-intermediate hepatocellular carcinoma in a 10-year single-center comparative study

BMC Gastroenterology ◽

10.1186/s12876-021-01765-x ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Liangliang Yan ◽

Yanqiao Ren ◽

Kun Qian ◽

Xuefeng Kan ◽

Hongsen Zhang ◽

...

Keyword(s):

Hepatocellular Carcinoma ◽

Radiofrequency Ablation ◽

Combination Therapy ◽

Clinical Outcomes ◽

Transarterial Chemoembolization ◽

Response Rate ◽

Multivariable Analysis ◽

Complication Rates ◽

Tace Treatment

Abstract Background Transarterial chemoembolization (TACE) and radiofrequency ablation (RFA) are effective treatment methods for unresectable hepatocellular carcinoma (HCC). However, there is still a lack of clinical research on whether early sequential RFA, compared with late combination therapy, can improve the long-term efficacy of initial TACE treatment. Methods This retrospective study investigated a cohort of patients who underwent combination therapy using TACE and RFA (TACE followed by RFA) from January 2010 to January 2020 at our medical centre. A total of 96 patients underwent TACE combined with early RFA (usually during the first hospitalization), which was called TACE + eRFA. Thirty-four patients received 1–2 palliative TACE treatments first and then underwent TACE treatment combined with late RFA (TACE + lRFA). All patients continued to receive palliative TACE treatments after intrahepatic lesion progression until reaching intolerance. The overall survival (OS) rate, time to tumour progression (TTP), tumour response rate and major complication rates were compared between the two groups. Results There were significant differences in the median OS (46 months vs 33 months; P = 0.013), median TTP (28 months vs 14 months; P < 0.00), objective response rate (ORR) (89.6% vs 61.8%, P = 0.000) and disease control rate (DCR) (94.8% vs 73.5% P = 0.002) between the two groups. Multivariable analysis revealed that the Barcelona Clinic Liver Cancer stage was an independent risk factor for OS. Meanwhile, multivariable analysis revealed that TACE + eRFA was associated with an enhanced TTP. Conclusion Early sequential RFA treatment in patients with early-intermediate HCC can improve local tumour control and clinical outcomes while reducing the frequency of TACE treatment. In clinical practice, in HCC patients initially treated with TACE, it is recommended to combine RFA as soon as possible to obtain long-term survival.

Download Full-text