Diaphragmatic perforation with colonic herniation due to hepatic radiofrequency ablation: A case report and review of the literature

Abstract

Radiofrequency ablation (RFA) has been widely accepted as an alternative treatment for unresectable primary and metastatic hepatic tumors, with satisfactory rates of local response and significant improvements in rates of overall survival. Numerous large series studies have shown that RFA is safe and effective, with a low mortality rate and a low major complication rate. Major complications, including diaphragmatic perforation and hernia, have rarely been previously reported. The current case report presents a case of diaphragmatic hernia with perforation of the incarcerated colon in the thoracic cavity 12 months following hepatic RFA, and reviews nine previously reported cases of diaphragmatic hernia. Comprehensive analysis of the nine cases demonstrated possibilities leading to diaphragmatic hernia following diaphragmatic thermal injury as a consequence of hepatic RFA. Clinicians and radiologists must consider diaphragmatic thermal damage following hepatic RFA for liver tumors adjacent to the diaphragm, particularly for patients with symptoms of ileus, dyspnea, chest pain, pleural effusion and right shoulder pain.

Keywords: diaphragmatic perforation; hepatocellular carcinoma; hernia; major complication; radiofrequency ablation.

Figure 1

Abdominal CT image following hepatic RFA shows a wedge-shaped lesion of ablation extending to the outer edge of segment VIII in the liver. A low-density lesion 1.5 cm in diameter represents the location of the hepatic tumor, as indicated by the white arrow. CT, computed tomography; RFA, radiofrequency ablation.

Figure 2

Chest X-ray shows a right pleural effusion and enlarged bowel in the chest cavity.

Figure 3

A coronal thoracic CT image shows a right diaphragmatic defect and loops of the bowel protruding into the thoracic cavity, as indicated by the white arrow. CT, computed tomography.