A case of diaphragmatic hernia induced by percutaneous radiofrequency ablation under the artificial pleural effusion for the hepatocellular carcinomas after 13 month period

A 84-year-old man who had been treated with percutaneous radiofrequency ablation (PRFA) under the artificial pleural effusion for hepatocellular carcinoma in the liver S8 was admitted to our hospital 13 months later from PRFA because of severe abdominal pain and vomiting. Plain CT revealed a diaphragmatic hernia with slided small intestine into the right thoracic cavity. We diagnosed the case as ileus with diaphragmatic hernia caused by PRFA. Although he was treated conservatively, he died from sepsis based on the ileus on the 11th hospital day. It was suggested PRFA close to the diaphragm induced diaphragmatic hernia 13 months later from PRFA procedure. In cases of HCC locating at sites adjacent to surrounding organs such as the diaphragm, gall bladder, or intestine, careful PRFA procedure and follow-up observation are necessary. The numbers of late complications including this case may increase by the accumulation of PRFA cases and longer-term observation.