Late-onset diaphragmatic hernia after percutaneous radiofrequency ablation of hepatocellular carcinoma: a case study

Abe, Tomoyuki; Amano, Hodaka; Takechi, Hitomi; Fujikuni, Nobuaki; Sasada, Tatsunari; Yoshida, Makoto; Yamaki, M.; Nakahara, Masaaki; Noriyuki, Toshio

doi:10.1186/s40792-016-0148-3

Cited by 14 publications

(12 citation statements)

References 18 publications

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“…In this case, a DH with acute intestinal obstruction and necrosis occurred 52 months after RFA, after emergency surgery, the patient recovered and was discharged successfully. According to previous literature reports [11][12][13][14][15][16][17][18][19][20][21][22] , the occurrence time of DH after RFA is 7-96 months (median 18 months), combined with our case, DH is considered to be a long-term complication of RFA, which is consistent with the occurrence mechanism of acquired diaphragmatic hernia, suggesting that for patients after RFA, the occurrence of DH should be vigilant during long-term follow-up.…”

Section: Discussionsupporting

confidence: 86%

Acute Intestinal Necrosis due to Diaphragmatic Hernia after Radiofrequency Ablation for Hepatocellular Carcinoma: A Case Report and Literature Review

Li¹,

Shen²,

Tao³

et al. 2021

Preprint

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Background: Radiofrequency ablation is widely used as an effective and minimally invasive treatment of hepatocellular carcinoma. The complications of radiofrequency ablation are mainly associated with needle damage or local thermal damage, while the reports of long-term complications of radiofrequency ablation are relatively rare.Case Report: This report presents a case of hepatocellular carcinoma with diaphragmatic hernia after radiofrequency ablation. A 60-year-old male came to the hospital with sudden abdominal pain for one day, who had received radiofrequency ablation and transcatheter arterial chemoembolization treatment for hepatocellular carcinoma located in segment 8 as an initial treatment 52 months ago. Computed tomography showed the right diaphragmatic hernia, small intestine intruding into the chest with intestinal obstruction. The patient underwent an emergency diaphragmatic repair with bowel resection and was successfully discharged 1 week after the operation.Conclusion: Diaphragmatic hernia is a long-term complication of radiofrequency ablation. Surgical treatment is recommended as the first choice when conditions permitted.

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Section: Discussionsupporting

confidence: 86%

Acute Intestinal Necrosis due to Diaphragmatic Hernia after Radiofrequency Ablation for Hepatocellular Carcinoma: A Case Report and Literature Review

Li¹,

Shen²,

Tao³

et al. 2021

Preprint

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“…There was no description of late-phase diaphragmatic hernia in three studies [5] [6] [7]. However, in some reports, cases of late-phase diaphragmatic hernia required an emergency surgery because of a strangulated intestine [8] [10]- [18]. Diaphragmatic hernia after RFA seems to be caused by thermal damage to the diaphragm.…”

Section: Discussionmentioning

confidence: 99%

Radiofrequency Ablation-Associated Delayed Diaphragmatic Hernia Treated with the Thoracolaparotomy Approach: A Case Report

Yamane¹,

Kohashi²,

Omori³

et al. 2016

CRCM

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Background: Radiofrequency ablation (RFA) is an effective treatment for hepatocellular carcinoma (HCC). However, rare but serious complications may occur after RFA. We describe a case of diaphragmatic hernia associated with RFA. Case Presentation: A 68-year-old man with a history of hepatitis Crelated liver cirrhosis was admitted to our hospital because of lower abdominal pain. Three years earlier, he underwent RFA for HCC in segment 8. Computed tomography revealed that the intestine was intruding into the right thoracic cavity through a diaphragmatic hernia. On the basis of the diagnosis of right diaphragmatic hernia with a strangulated ileus, an emergency operation was performed. Perforation of the strangulated transverse colon into the right thoracic cavity was suspected, and a combined approach of laparotomy and thoracotomy was utilized. The operative findings showed that the diaphragmatic hernia was 3.5 × 2.0 cm in diameter, and it was simply sutured with a nonabsorbable suture material. Resection of the intruded ischemic transverse colon was completed, and a covering ileostomy was performed. The patient was discharged without any complications. Conclusions: RFA is widely used for the treatment of HCC. Reports of early-and late-phase complications indicate that heat damage contributes to the fragility of neighboring organs. The occurrence of diaphragmatic hernia after RFA is one of the delayed complications. Although it rarely occurs, this complication requires emergency surgery. In conclusion, if perforation of the intestine into the thoracic cavity is suspected, thoracolaparotomy should be considered as a treatment option to How to cite this paper:

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“…Tabrizian et al reported that 5.4 % of 55 patients who underwent hepatic resection with concomitant diaphragmatic resection and repair developed iatrogenic DH [ 1 ]. Fragility of the diaphragm due to thermal damage or resection can cause iatrogenic DH [ 1 , 10 ], and there is no way to prevent such DH from occurring other than to ensure intraoperative diaphragmatic repair. Most of the reported iatrogenic DH cases presented with stomach or intestinal incarceration were symptomatic and required surgical treatment [ 1 , 10 ].…”

Section: Case Presentationmentioning

confidence: 99%

“…Fragility of the diaphragm due to thermal damage or resection can cause iatrogenic DH [ 1 , 10 ], and there is no way to prevent such DH from occurring other than to ensure intraoperative diaphragmatic repair. Most of the reported iatrogenic DH cases presented with stomach or intestinal incarceration were symptomatic and required surgical treatment [ 1 , 10 ]. The anatomic location of the liver minimizes the possibility of a right-sided intestinal or stomach incarceration, and there is no report of the surgical indication for iatrogenic hepatic herniation alone.…”

Section: Case Presentationmentioning

confidence: 99%

Follow-up of asymptomatic adult diaphragmatic hernia: should patients with this condition undergo immediate operation? A report of two cases

et al. 2016

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BackgroundAsymptomatic diaphragmatic hernia is generally thought to be rare among adults. We present two different types of asymptomatic diaphragmatic hernia diagnosed with computed tomography (CT) and discuss treatment strategies.Case presentationCase 1: A 37-year-old woman was diagnosed with catamenial pneumothorax in the right diaphragm. Partial resection of the diaphragm and lung was performed using a linear stapler. She was asymptomatic after the operation and gave birth 2 years later. After delivery, she experienced recurrent pneumothorax, and CT revealed a right diaphragmatic defect with herniation of a part of the liver into the thorax. An iatrogenic diaphragmatic hernia was diagnosed. There has been no change in the size of the hernia and no symptoms due to the diaphragmatic hernia for more than 3 years after it was diagnosed.Case 2: A 75-year-old woman was previously diagnosed with rectal cancer and had undergone surgery after chemoradiotherapy. One year after surgery, herniation of a 3 × 1.3-cm section of retroperitoneal fat tissue into the left thoracic cavity was observed incidentally at a follow-up CT and was diagnosed as an adult Bochdalek hernia (BH). We reviewed the patient’s past CT findings and confirmed that the same finding had been present since the first scan. A wait-and-see approach was chosen because there had been no change in the size of hernia, there were no symptoms, the patient was elderly, and there was a high risk of recurrence of the rectal cancer. She has had no symptoms to date, and careful follow-up has been performed.ConclusionsThere are few reports of asymptomatic adult diaphragmatic hernia. Although symptomatic diaphragmatic hernia is generally treated surgically, there are cases in which a wait-and-see approach has been applied, such as our asymptomatic cases.

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Late-onset diaphragmatic hernia after percutaneous radiofrequency ablation of hepatocellular carcinoma: a case study

Cited by 14 publications

References 18 publications

Acute Intestinal Necrosis due to Diaphragmatic Hernia after Radiofrequency Ablation for Hepatocellular Carcinoma: A Case Report and Literature Review

Acute Intestinal Necrosis due to Diaphragmatic Hernia after Radiofrequency Ablation for Hepatocellular Carcinoma: A Case Report and Literature Review

Radiofrequency Ablation-Associated Delayed Diaphragmatic Hernia Treated with the Thoracolaparotomy Approach: A Case Report

Follow-up of asymptomatic adult diaphragmatic hernia: should patients with this condition undergo immediate operation? A report of two cases

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