Abstract
Diaphragmatic hernia is one of delayed complications of radiofrequency ablation (RFA), and there are some severe cases due to underlying cirrhosis of the liver or impaction. We experienced a case of diaphragmatic hernia occurred 19 months after percutaneous RFA. An 86-year-old man who had been treated for liver cirrhosis C at our hospital was found to have hepatocellular carcinoma, 13 mm in size, in the S5/8 area of the liver. RFA was performed. The patient visited the emergency room 19 months after RFA because of right upper quadrant pain and constipation. Chest X-ray showed intestinal gas in the right lower lung field, and a large defect 4-5 cm in diameter in the right diaphragm and prolapse in the right thoracic cavity of the transverse colon were observed by abdominal CT scan. Diaphragmatic hernia was diagnosed, and an emergency laparotomy was performed. We observed a 5 cm-sized hernia orifice in the right diaphragm next to the RFA scar and impaction of the transverse colon/greater omentum in the right thoracic cavity. No necrosis was observed in the impacted colon, and the defect was closed by direct suture. After RFA, we would be required long-term follow-up and early treatment not to miss a good timing for surgery at the onset of the hernia.
