臨床症例報告ジャーナル

Laparoscopic Repair of Diaphragmatic Perforation with Colonic Herniation Following Hepatic Radiofrequency Ablation: A Case Report

Abstract

Yusuke Yamamoto, Teiichi Sugiura, Yukiyasu Okamura, Takaaki Ito, Ryo Ashida, Yoshiyasu Kato, Katsuhisa Ohgi, Mihoko Yamada, Rui Sato, Takeshi Aramaki and Katsuhiko Uesaka

Background: Diaphragmatic hernia is a rare complication after hepatic radiofrequency ablation (RFA). We herein present a case of a patient who underwent laparoscopic repair of diaphragmatic perforation with colonic herniation occurring 12 months after hepatic RFA.

Case presentation: An 80-year-old man underwent RFA under computed tomography guidance using a cool-tip radiofrequency probe with a short trans-thoracic root for hepatocellular carcinoma in segment VIII. Twelve months later, he developed a large amount of right pleural effusion and a right diaphragmatic hernia containing the colon and mesentery. After drainage of the right pleural effusion, the patient underwent laparoscopic repair of the diaphragmatic perforation with colonic herniation. Severe adhesion was noted between nearly the entire herniated colon and lung; however, we were able to remove the herniated colon from the thoracic cavity safely. Bowel resection was not required. Finally, simple running sutures of the diaphragmatic defect using 2-0 Vicryl were laid down. There were no postoperative complications, and the patient was discharged nine days after surgery.

Conclusions: Diaphragmatic hernia is rare but should be recognized as a late complication following hepatic RFA. Surgical repair of a diaphragmatic hernia, including minimally invasive surgery using the laparoscopic approach, especially for patients with cirrhosis, should be considered in order to avoid acute intestinal obstruction or perforation.