A Case of Incarcerated Diaphragmatic Hernia after Percutaneous Radiofrequency Ablation for Hepatocellular Carcinoma

Ryutaro Sakabe, Yoshinori Yamashita, Naoki Hirabayashi, Wataru Takiyama, Yoshie Kobayashi, Minoru Kameoka, Akira Nakashima, Yukio Sato, Shuji Saeki and Hidenori Mukaida

Department of Surgery, Hiroshima City Asa Hospital

Although radiofrequency ablation is a minimally invasive treatment for hepatic tumors, serious complications of thermal damage to the surrounding organs such as colon perforation, bile duct injury, and diaphragmatic injury have been reported. We report a case of incarcerated diaphragmatic hernia due to thermal damage after radiofrequency ablation for hepatocellular carcinoma. A 75-year-old man admitted for sudden abdominal pain onset and abdominal distension had previously undergone hepatic artery injection treatment and radiofrequency ablation for hepatocellular carcinoma at hepatic segments IV, VII, and VIII. Chest X-ray showed an abnormal gas shadow above the right diaphragm and computed tomography showed herniation of the hepatic flexure of the colon into the right thoracic cavity. He was diagnosed with ileus due to incarcerated diaphragmatic hernia necessitating emergency surgery. The hernia orifice was 3 cm in diameter and adjacent to the hepatocellular carcinoma treated by radiofrequency ablation. He underwent right hemicolectomy, ileostomy, and repair of the hernia orifice. He recovered well and was discharged on postoperative day 149.

Key words
diaphragmatic hernia, radiofrequency ablation, hepatocellular carcinoma

Reprint requests
Ryutaro Sakabe Department of Surgery, Hiroshima City Asa Hospital
2-1-1 Kabeminami, Asakita-ku, Hiroshima, 731-0293 JAPAN

Accepted
June 27, 2007

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