Postoperative hepatic encephalopathy following laparoscopic repair of diaphragmatic hernia after radiofrequency ablation: a case report and literature review

TL;DR

A 77-year-old woman developed hepatic encephalopathy due to colonic stenosis after laparoscopic repair of a diaphragmatic hernia following cancer treatment.

Contribution

First reported case of secondary hepatic encephalopathy caused by colonic stenosis after laparoscopic hernia repair following radiofrequency ablation.

Findings

Hepatic encephalopathy was caused by severe fecal impaction due to colonic stenosis.

Laparoscopic repair of diaphragmatic hernia was feasible but required long-term monitoring.

Colonic stenosis was resolved with balloon dilation, leading to recovery from encephalopathy.

Abstract

This case report describes a rare, late complication of radiofrequency ablation for hepatocellular carcinoma. A 77-year-old woman with a history of hepatocellular carcinoma presented with an incarcerated diaphragmatic hernia (DH), which was successfully repaired using emergency laparoscopic surgery. However, 2 months later, she developed hepatic encephalopathy due to severe fecal impaction. Imaging and endoscopy revealed significant colonic stenosis at the hernia repair site. The stenosis was successfully resolved with two sequential balloon dilations, leading to a complete recovery from the encephalopathy. This is the first reported case of secondary hepatic encephalopathy caused by colonic stenosis following laparoscopic repair of DH after radiofrequency ablation. This report demonstrates the feasibility of laparoscopic surgery for DH and emphasizes the necessity for meticulous long-term monitoring to avoid such rare but serious delayed complications.

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