Video-assisted thoracic surgery in a patient with diaphragmatic hernia after radiofrequency ablation for hepatocellular carcinoma

概要

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The patient was an 80-year-old woman with dyspnea. She had repeatedly undergone radiofrequency ablation (RFA) and transcatheter arterial embolization for hepatocellular carcinoma (HCC) associated with type C cirrhosis in our hospital. Computed tomography revealed right pleural effusion and that the large intestine had herniated into the thoracic cavity through the defect of the diaphragm. Overswelled vessels in the abdominal wall due to portal hypertension and severe atrophy of the liver were also recognized. No signs of ileus were observed. Diaphragmatic hernia after RFA was suspected, and surgery was performed. Magnetic resonance imaging after RFA for an S6 lesion revealed that the diaphragm had been damaged by the heat of the ablation and was torn. That was considered to be the cause of the diaphragmatic hernia. Laparotomy would increase the risk of postoperative hepatic failure because it can reduce the hepatic blood flow and injure the abnormal vessels of the abdominal wall. Video-assisted thoracic surgery (VATS) was performed. The large intestine and greater omentum were repositioned into the abdomen, and the direct closure of the diaphragmatic defect of about 3 cm in size was carried out. VATS was a safe and effective approach in this case.