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

Ryo Kurosaki, Toshifumi Wakai, Yoshio Shirai, Tatsuya Nomura, Satoshi Maruyama, Suguru Ishikawa and Katsuyoshi Hatakeyama

Division of Digestive and General Surgery, Niigata University Graduate School of Medical and Dental Sciences

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 1.5 cm 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 2 cm 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.

Key words
radiofrequency ablation, diaphragmatic hernia, complication

Reprint requests
Ryo Kurosaki Division of Digestive and General Surgery, Niigata University Graduate School of Medical and Dental Sciences
1-757 Asahimachi-dori, Chuo-ku, Niigata, 951-8510 JAPAN

Accepted
November 28, 2007

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