Abstract
A 76-year-old man was admitted due to epigastralgia and right lower chest pain. He had undergone 5 sessions of percutaneous radiofrequency ablation (RFA) for hepatocellular carcinoma. Abdominal CT revealed a rupture of the right diaphragm and invagination of the transverse colon into the right thoracic cavity. The patient was found to have severe liver cirrhosis and atrophic change in the right lobe. A diaphragmatic hernia was diagnosed following percutaneous RFA. Since the pain disappeared the next day and symptoms of intestinal ischemia and ileus were not seen, elective laparoscopic surgery was scheduled. The invagination of the transverse colon was found to have been reduced by the time the operation was done. A defect of the diaphragm 6 × 3.5 cm in size that was caused by a burn due to RFA was found. It was closed by laparoscopic suturing and covered with composite mesh from the abdominal cavity side. The postoperative course was uneventful. Diaphragmatic hernia repair following RFA is rare ; only 14 cases have been reported in Japan. Laparoscopic operation appears to be a safe and useful option when the reduction of hernia contents is not difficult to accomplish.
