Nagasu S, Okuda K, Kuromatsu R, Nomura Y, Torimura T, Akagi Y. Surgically treated diaphragmatic perforation after radiofrequency ablation for hepatocellular carcinoma. World J Gastrointest Surg 2017; 9(12): 281-287 [PMID: 29359034 DOI: 10.4240/wjgs.v9.i12.281]
Corresponding Author of This Article
Sachiko Nagasu, PhD, Department of Gastrointestinal Surgery, Kurume University, 67 Asahi-machi Kurume, Fukuoka 8300011, Japan. shiraiwa_sachiko@med.kurume-u.ac.jp
Research Domain of This Article
Gastroenterology & Hepatology
Article-Type of This Article
Case Report
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Sachiko Nagasu, Yoshito Akagi, Department of Gastrointestinal Surgery, Kurume University, Fukuoka 8300011, Japan
Koji Okuda, Yoriko Nomura, Department of Hepato-biliary and Pancreatic Surgery, Kurume University, Fukuoka 8300011, Japan
Ryoko Kuromatsu, Takuji Torimura, Department of Gastroenterological Medicine, Kurume University, Fukuoka 8300011, Japan
Author contributions: Nagasu S and Okuda K made substantial contributions to the conception or design of the work, the acquisition, analysis, and interpretation of data for the work; Okuda K, Kuromatsu R, Nomura Y, Torimura T and Akagi Y contributed to the drafting of the work or revising it critically for important intellectual content; all authors provided final approval of the version to be published and agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.
Informed consent statement: This is a retrospective study, as we are taking personal information measures, there is no possibility of suffering disadvantages.
Conflict-of-interest statement: No conflict-of-interest was available.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Sachiko Nagasu, PhD, Department of Gastrointestinal Surgery, Kurume University, 67 Asahi-machi Kurume, Fukuoka 8300011, Japan. shiraiwa_sachiko@med.kurume-u.ac.jp
Telephone: +81-942-353311 Fax: +81-942-326278
Received: August 7, 2017 Peer-review started: August 8, 2017 First decision: September 7, 2017 Revised: September 18, 2017 Accepted: November 25, 2017 Article in press: November 25, 2017 Published online: December 27, 2017 Processing time: 141 Days and 22.9 Hours
ARTICLE HIGHLIGHTS
Case characteristics
In the case of diaphragmatic perforation with herniation after radiofrequency ablation (RFA), symptoms, such as upper abdominal pain or dyspnea, develop suddenly, while in the case of perforation without herniation, there may be no symptoms.
Clinical diagnosis
Diaphragmatic perforation with or without herniation after radiofrequency ablation for hepatocellular carcinoma.
Differential diagnosis
In case of acute onset, it is necessary to distinguish from acute abdomen and respiratory failure and the history of RFA for hepatocellular carcinoma located adjacent to the diaphragm and computed tomography (CT) findings would be helpful to diagnose.
Laboratory diagnosis
In the case of diaphragmatic perforation with and without herniation after RFA, liver function, such as Child-Pugh score, may decline in many cases.
Imaging diagnosis
In the case of diaphragmatic perforation with herniation after RFA, a right diaphragm defect and herniated viscera in the right pleural cavity is identified on coronal dynamic CT image.
Pathological diagnosis
There were no pathological findings as all cases may undergo direct discontinued sutures without trimming in this study.
Treatment
Diaphragm perforation and herniation, particularly with symptoms, must be surgically repaired as much as possible, but when there is not ileus, intestinal necrosis and breathing disorder, it is not necessary to hurry.
Experiences and lessons
In performing RFA for liver tumors located adjacent to the diaphragm, clinicians must devise methods for avoiding thermal injury of the diaphragm and regularly monitor the integrity of the diaphragm to achieve early diagnosis of defects over a long-term postoperative follow up.
