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

  • 黒崎 亮
    新潟大学大学院医歯学総合研究科消化器・一般外科学分野
  • 若井 俊文
    新潟大学大学院医歯学総合研究科消化器・一般外科学分野
  • 白井 良夫
    新潟大学大学院医歯学総合研究科消化器・一般外科学分野
  • 野村 達也
    新潟大学大学院医歯学総合研究科消化器・一般外科学分野
  • 丸山 聡
    新潟大学大学院医歯学総合研究科消化器・一般外科学分野
  • 石川 卓
    新潟大学大学院医歯学総合研究科消化器・一般外科学分野
  • 畠山 勝義
    新潟大学大学院医歯学総合研究科消化器・一般外科学分野

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タイトル別名
  • Incarcerated Diaphragmatic Hernia as a Late Complication of Radiofrequency Ablation for Hepatocellular Carcinoma

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説明

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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