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. 2021 Sep 16;7(1):206.
doi: 10.1186/s40792-021-01291-8.

Laparoscopic surgery for strangulated diaphragmatic hernia after radiofrequency ablation for hepatocellular carcinoma: a case report

Yasuaki Kimura  1   2 , Daisuke Ishioka  3   4 , Hidenori Kamiyama  3 , Shingo Tsujinaka  4 , Toshiki Rikiyama  4
Affiliations

Laparoscopic surgery for strangulated diaphragmatic hernia after radiofrequency ablation for hepatocellular carcinoma: a case report

Yasuaki Kimura et al. Surg Case Rep. .

Abstract

Background: Percutaneous radiofrequency ablation (RFA) is an effective treatment for hepatocellular carcinoma (HCC), but delayed thermal damage can cause diaphragmatic hernia (DH). Surgery is recommended for DH, and open surgery is widely accepted. This report presents a case of laparoscopic surgery for strangulated DH that occurred after RFA.

Case presentation: An 80-year-old woman with a history of hepatitis C-induced liver cirrhosis and HCC was admitted to our institution owing to sudden-onset intense epigastric pain. Twenty-two months earlier, she received RFA treatment for HCC located in segment 6/7. Contrast-enhanced computed tomography revealed herniation of the small intestine into the thoracic cavity, with mesenteric fat haziness. Emergency laparoscopic surgery was performed, and the patient was diagnosed with strangulated DH associated with the prior RFA. The defect was closed using absorbable sutures, and the ischaemic small intestine was resected via mini-laparotomy. The patient was discharged on the 10th postoperative day without complications, and no evidence of DH recurrence 15 months after surgery was noted.

Conclusions: Laparoscopic surgery seems useful and feasible for strangulated DH.

Keywords: Complication; Diaphragmatic hernia; Laparoscopic surgery; Radiofrequency ablation; Strangulated hernia.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Fig. 1
Fig. 1
Chest radiography. Chest radiography reveals a massive abnormal intestinal gas above the right lobe of the liver
Fig. 2
Fig. 2
A Contrast-enhanced computed tomography (CT). Contrast-enhanced CT showing herniation of the small intestine into the thoracic cavity. B Coronal CT image. Coronal CT images showing loops of the small intestine in the thoracic cavity
Fig. 3
Fig. 3
Diaphragmatic hernia (DH). The small intestine is strangulated by the defect in the right side of the diaphragm (arrowheads). The location of the radiofrequency ablation-treated tumour coincides with the site of DH (arrows)
Fig. 4
Fig. 4
Hernial orifice. The diameter of the hernia defect was approximately 2 cm. The diaphragmatic tissue around the hernial orifice was not fragile by tactile sensation
Fig. 5
Fig. 5
Simple suture repair of the defect
See this image and copyright information in PMC

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