title: Successful surgical rescue of delayed onset diaphragmatic hernia following radiofrequency ablation for hepatocellular carcinoma.
abstract: Radiofrequency ablation (RFA) has been established as the mainstay therapy for hepatocellular carcinoma (HCC) in patients deemed unsuitable for surgical resection. However, delayed diaphragmatic hernia can occur as a result of this procedure. There have been only seven other cases reported on this complication in the literature. Considering the recent growth in the popularity of the procedure, it is predictable that the incidence of the diaphragmatic hernia, due to RFA, will definitely increase. This case report is therefore vitally important as it increases clinical awareness of this currently rare complication, which could lead to improved survival rates in these patients. This case concerns an 81-year-old Asian man with a past medical history of cirrhosis and HCC (segment IV and VIII) who presented with a delayed, right diaphragmatic hernia and strangulated ileus 18 months after his original RFA procedure. It is important to implement extra measures to limit the risk of diaphragmatic, thermal injuries when RFA is performed. In particular, gastroenterologists, surgeons and accident and emergency staff should all be aware of this complication proceed with rapid diagnosis and management when patients, who previously underwent RFA, present with acute abdominal pain.
authors.affiliation: Department of Organ Transplantation and General Surgery, Kyoto Prefectural University of Medicine, Kyoto, Japan; Department of Surgery, Omihachiman Community Medical Center, Shiga, Japan. tsukasa@koto.kpu-m.ac.jp.
authors.forename: Tsukasa
authors.initials: T
authors.lastname: Nakamura
authors.affiliation: Department of Surgery, Omihachiman Community Medical Center, Shiga, Japan.
authors.forename: Koji
authors.initials: K
authors.lastname: Masuda
authors.affiliation: Department of Hepatobiliary and Pancreatic Surgery, St. James's University Hospital, Leeds, United Kingdom.
authors.forename: Rajveer Singh
authors.initials: RS
authors.lastname: Thethi
authors.affiliation: Department of Surgery, Omihachiman Community Medical Center, Shiga, Japan.
authors.forename: Hirotaka
authors.initials: H
authors.lastname: Sako
authors.affiliation: Department of Gastroenterology and Hepatology, Omihachiman Community Medical Center, Shiga, Japan.
authors.forename: Takaharu
authors.initials: T
authors.lastname: Yoh
authors.affiliation: Department of Organ Transplantation and General Surgery, Kyoto Prefectural University of Medicine, Kyoto, Japan.
authors.forename: Toshimasa
authors.initials: T
authors.lastname: Nakao
authors.affiliation: Department of Organ Transplantation and General Surgery, Kyoto Prefectural University of Medicine, Kyoto, Japan.
authors.forename: Norio
authors.initials: N
authors.lastname: Yoshimura
mesh_terms: D000369:Aged, 80 and over; D006528:Carcinoma, Hepatocellular / Q000628:therapy*; D017115:Catheter Ablation / Q000009:adverse effects*; D006548:Hernia, Diaphragmatic / Q000209:etiology* / Q000601:surgery*; D006801:Humans; D008113:Liver Neoplasms / Q000628:therapy*; D008297:Male