Morito Atsushi, Nakagawa Shigeki, Imai Katsunori, Uemura Norio, Okabe Hirohisa, Hayashi Hiromitsu, Yamashita Yo-Ichi, Chikamoto Akira, Baba Hideo
Department of Gastroenterological Surgery, Graduate School of Life Sciences, Kumamoto University, 1-1-1 Honjo, Kumamoto, 860-0811, Japan.
Department of Gastroenterological Surgery, Graduate School of Medical Sciences, Kumamoto University, 1-1-1 Honjo, Chuo-ku, Kumamoto, 860-8556, Japan.
Surg Case Rep. 2021 May 26;7(1):130. doi: 10.1186/s40792-021-01213-8.
Radiofrequency ablation (RFA) is widely used as a minimally invasive treatment for hepatocellular carcinoma (HCC). RFA has a low risk of complications, especially compared with liver resection. Nevertheless, various complications have been reported after RFA for HCC; however, diaphragmatic hernia (DH) is extremely rare.
A 78-year-old man underwent thoracoscopic RFA for HCC located at the medial segment adjacent to the diaphragm approximately 7 years before being transported to the emergency department due complaints of nausea and abdominal pain. Computed tomography revealed a prolapsed small intestine through a defect in the right diaphragm, and emergency surgery was performed. The cause of diaphragmatic hernia was the scar of RFA. We confirmed that the small intestine had prolapsed into the right diaphragm, and we resected the necrotic small intestine and repaired the right diaphragm. Herein, we report a case of ileal strangulation due to diaphragmatic hernia after thoracoscopic RFA.
Care should be taken when performing thoracoscopic RFA, especially for tumors located on the liver surface adjacent to the diaphragm. Patients should be carefully followed up for possible DH, even after a long postoperative interval.
射频消融术（RFA）作为肝细胞癌（HCC）的一种微创治疗方法被广泛应用。RFA的并发症风险较低，尤其是与肝切除术相比。然而，已有报道称RFA治疗HCC后出现了各种并发症；不过，膈疝（DH）极为罕见。
一名78岁男性因恶心和腹痛主诉被送往急诊科，约7年前曾因位于靠近膈肌的内侧段的HCC接受了胸腔镜下RFA。计算机断层扫描显示小肠通过右膈肌的缺损处脱垂，遂进行了急诊手术。膈疝的病因是RFA的瘢痕。我们确认小肠已脱垂至右膈肌，切除了坏死的小肠并修复了右膈肌。在此，我们报告一例胸腔镜下RFA术后因膈疝导致回肠绞窄的病例。
进行胸腔镜下RFA时应谨慎，特别是对于位于肝脏表面靠近膈肌的肿瘤。即使术后间隔时间较长，也应对患者进行仔细随访，以排查可能发生的DH。
