Two cases of diaphragmatic hernia following percutaneous radiofrequency ablation of hepatocellular carcinoma

Radiofrequency ablation (RFA) is a minimally invasive treatment for small hepatocellular carcinoma Although RFA of the liver has a low complication rate, thermal damage from heating has been documented as a specific complication of RFA. Here, we report two cases of diaphragmatic hernia following percutaneous RFA of hepatocellular carcinoma. Thermal damage to the diaphragm was confirmed to be adjacent to the RFA treated region. Diaphragmatic hernia occurred 78weeks (Case1) and 112weeks (Case2) after ablation. But defects of the diaphragms had already occurred 65weeks (Case1) and 42weeks (Case2) after treatment, and remained quiescent until bowel herniated through the defects. Adding to the defect of diaphragm, a mechanism that induces the interposition of the intestine between the liver and the diaphragm (liver atrophy, ascites, abdominal pressure, etc.) are thought to be necessary to trigger herniation. We recommend that hepatocellular carcinoma adjacent to diaphragm should be treated using procedures such as artificial ascites or a laparoscopic approach to separate the lesion from diaphragm.