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

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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Liver Cirrhosis and Hepatocellular Carcinoma Diagnosed from Chylothorax: A Case Report

Clinics and Practice ◽

10.3390/clinpract11030073 ◽

2021 ◽

Vol 11 (3) ◽

pp. 582-586

Author(s):

Kenta Ito ◽

Yoshimasa Hachisu ◽

Mitsuhiko Shibasaki ◽

Kazuma Ezawa ◽

Hiroshi Iwashita ◽

...

Keyword(s):

Computed Tomography ◽

Hepatocellular Carcinoma ◽

Liver Cirrhosis ◽

Case Report ◽

Pleural Effusion ◽

Malignant Lymphoma ◽

Review Of The Literature ◽

Left Pleural Effusion ◽

History Of

A 71-year-old man visited our hospital with dyspnea and left pleural effusion. Left pleural effusion was diagnosed as chylothorax by thoracentesis. He had no history of trauma or surgery, and there were no findings of malignant lymphoma or thrombosis. Furthermore, he was diagnosed with liver cirrhosis and hepatocellular carcinoma by computed tomography and hematological examinations, and the chylothorax was considered to be caused by liver cirrhosis. We report a review of the literature with this case since it is relatively rare for cirrhosis and hepatocellular carcinoma diagnosed from chylothorax.

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Laparoscopic surgery for strangulated diaphragmatic hernia after radiofrequency ablation for hepatocellular carcinoma: a case report

Surgical Case Reports ◽

10.1186/s40792-021-01291-8 ◽

2021 ◽

Vol 7 (1) ◽

Author(s):

Yasuaki Kimura ◽

Daisuke Ishioka ◽

Hidenori Kamiyama ◽

Shingo Tsujinaka ◽

Toshiki Rikiyama

Keyword(s):

Hepatocellular Carcinoma ◽

Small Intestine ◽

Laparoscopic Surgery ◽

Radiofrequency Ablation ◽

Diaphragmatic Hernia ◽

Epigastric Pain ◽

Sudden Onset ◽

Absorbable Sutures ◽

History Of ◽

Enhanced Computed Tomography

Abstract Background Percutaneous radiofrequency ablation (RFA) is an effective treatment for hepatocellular carcinoma (HCC), but delayed thermal damage can cause diaphragmatic hernia (DH). Surgery is recommended for DH, and open surgery is widely accepted. This report presents a case of laparoscopic surgery for strangulated DH that occurred after RFA. Case presentation An 80-year-old woman with a history of hepatitis C-induced liver cirrhosis and HCC was admitted to our institution owing to sudden-onset intense epigastric pain. Twenty-two months earlier, she received RFA treatment for HCC located in segment 6/7. Contrast-enhanced computed tomography revealed herniation of the small intestine into the thoracic cavity, with mesenteric fat haziness. Emergency laparoscopic surgery was performed, and the patient was diagnosed with strangulated DH associated with the prior RFA. The defect was closed using absorbable sutures, and the ischaemic small intestine was resected via mini-laparotomy. The patient was discharged on the 10th postoperative day without complications, and no evidence of DH recurrence 15 months after surgery was noted. Conclusions Laparoscopic surgery seems useful and feasible for strangulated DH.

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

Hepatology Research ◽

10.1111/j.1872-034x.2011.00865.x ◽

2011 ◽

Vol 41 (11) ◽

pp. 1132-1136 ◽

Cited By ~ 14

Author(s):

Mansher Singh ◽

Gayatri Singh ◽

Ambarish Pandey ◽

Charles H. Cha ◽

Sanjay Kulkarni

Keyword(s):

Hepatocellular Carcinoma ◽

Radiofrequency Ablation ◽

Diaphragmatic Hernia ◽

Laparoscopic Repair

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Leberzellkarzinom – Radiofrequenzablation: Welches Bildgebungsverfahren ist effektiver?

Gesundheitsökonomie & Qualitätsmanagement ◽

10.1055/a-0978-0094 ◽

2019 ◽

Vol 24 (04) ◽

pp. 163-164

Author(s):

Cornelia Fietz

Keyword(s):

Computed Tomography ◽

Hepatocellular Carcinoma ◽

Radiofrequency Ablation ◽

Comparative Effectiveness ◽

Percutaneous Radiofrequency Ablation ◽

Ultrasound Guided ◽

Medicare Patients ◽

Us Dollar

Huo J et al. Comparative Effectiveness of Computed Tomography-Versus Ultrasound-Guided Percutaneous Radiofrequency Ablation Among Medicare Patients 65 Years of Age or Older With Hepatocellular Carcinoma. Value Health 2019; 22(3):284–292 Die Inzidenz des Leberzellkarzinoms hat sich in den letzen 20 Jahren mehr als verdoppelt. 2018 wurden in den USA mehr als 31 600 neue Fälle registriert, knapp die Hälfte dieser Patienten war älter als 65 Jahre. Die damit verbundenen jährlichen Kosten werden auf 455 Millionen US Dollar geschätzt. Für fortgeschrittene, inoperable Fälle steht die Radiofrequenzablation als Therapieoption zur Verfügung, die Ultraschall- oder Computertomographie-gestützt durchgeführt werden kann. Die Autoren vergleichen die Effektivität beider Bildgebungstechniken für das Verfahren.

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Faecopneumothorax due to missing diaphragmatic hernia: a case report

Journal of Medical Case Reports ◽

10.1186/s13256-020-02606-3 ◽

2021 ◽

Vol 15 (1) ◽

Author(s):

Resul Nusretoğlu ◽

Yunus Dönder

Keyword(s):

Computed Tomography ◽

Diaphragmatic Hernia ◽

Colon Resection ◽

Emergency Laparotomy ◽

Hernia Sac ◽

Case Presentation ◽

Abdominal Tenderness ◽

History Of ◽

Diaphragmatic Hernias ◽

Tomography Scan

Abstract Background Diaphragmatic hernias may occur as either congenital or acquired. The most important cause of acquired diaphragmatic hernias is trauma, and the trauma can be due to blunt or penetrating injury. Diaphragmatic hernia may rarely be seen after thoracoabdominal trauma. Case presentation A 54-year-old Turkish male patient admitted to the emergency department with abdominal pain and dyspnea ongoing for 2 days. He had general abdominal tenderness in all quadrants. He had a history of a stabbing incident in his left subcostal region 3 months ago without any pathological findings in thoracoabdominal computed tomography scan. New thoracoabdominal computed tomography showed a diaphragmatic hernia and fluid in the hernia sac. Due to respiratory distress and general abdominal tenderness, the decision to perform an emergency laparotomy was made. There was a 6 cm defect in the diaphragm. There were also necrotic fluids and stool in the hernia sac in the thorax colon resection, and an anastomosis was performed. The defect in the diaphragm was sutured. The oral regimen was started, and when it was tolerated, the regimen was gradually increased. The patient was discharged on the postoperative 11th day. Conclusions Acquired diaphragmatic hernia may be asymptomatic or may present with complications leading to sepsis. In this report, acquired diaphragmatic hernia and associated colonic perforation of a patient with a history of stab wounds was presented.

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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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