Incarcerated Diaphragmatic Hernia as a Late Complication of Radiofrequency Ablation for Hepatocellular Carcinoma

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  • Kurosaki Ryo
    Division of Digestive and General Surgery, Niigata University Graduate School of Medical and Dental Sciences
  • Wakai Toshifumi
    Division of Digestive and General Surgery, Niigata University Graduate School of Medical and Dental Sciences
  • Shirai Yoshio
    Division of Digestive and General Surgery, Niigata University Graduate School of Medical and Dental Sciences
  • Nomura Tatsuya
    Division of Digestive and General Surgery, Niigata University Graduate School of Medical and Dental Sciences
  • Maruyama Satoshi
    Division of Digestive and General Surgery, Niigata University Graduate School of Medical and Dental Sciences
  • Ishikawa Suguru
    Division of Digestive and General Surgery, Niigata University Graduate School of Medical and Dental Sciences
  • Hatakeyama Katsuyoshi
    Division of Digestive and General Surgery, Niigata University Graduate School of Medical and Dental Sciences

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Other Title
  • 肝細胞癌に対する経皮的ラジオ波焼灼療法による遅発性横隔膜ヘルニア嵌頓の１例

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The incidence of treatment-related complications after radiofrequency ablation (RFA) for liver tumors is low, and complications of diaphragmatic burns after RFA are rare. We report a rare post-RFA diaphragmatic hernia involving hepatocellular carcinoma (HCC) in the right subphrenic region. A 78-year-old woman admitted for HCC treatment arising from a cirrhotic liver was found in contrast-enhanced computed tomography to have a solitary HCC 1.5cm at its greatest dimension in Couinaud segment VIII. We conducted percutaneous ultrasound-guided RFA with artificial pleural effusion for a hepatic lesion beneath the right hemidiaphragm. One year later, she suffered coughing and dyspnea followed a few days later by abdominal distension and hepatic encephalopathy. Based on a diagnosis of small bowel obstruction caused by an incarcerated diaphragmatic hernia, we conducted laparotomy, finding an incarcerated ileal loop through a 2cm defect at the right hemidiaphragm adjacent to the previously ablated lesion and necessitating partial resection of the ileum and repair of the diaphragmatic hernia caused by RFA therapy. Clinicians must therefore consider such findings a late complication of RFA for hepatic tumors.

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