# Isolated Herniation of Gallbladder Through Diaphragmatic Defect Following Hepatic Microwave Ablation

## TL;DR

A rare case of gallbladder herniation through a diaphragmatic defect following liver ablation is reported, highlighting the importance of recognizing delayed complications.

## Contribution

This is the first reported case of isolated gallbladder herniation through a diaphragmatic defect after hepatic microwave ablation.

## Key findings

- Diaphragmatic herniation of the gallbladder occurred 2 years after microwave ablation.
- Surgical correction included robotic reduction, diaphragmatic closure, and cholecystectomy.
- Delayed symptoms after ablation are common and require awareness for better patient outcomes.

## Abstract

Thermal ablation is commonly used to control metastatic hepatic lesions. The documented overall major complication rate is low (4.1%), with a lower incidence of damage to organs (<0.7%). Diaphragmatic injuries resulting from thermal ablation can cause pain and pleural effusions and, rarely, herniation of intra-abdominal contents into the thoracic cavity.

We present a case of isolated gallbladder herniation through a diaphragmatic defect after microwave ablation. The patient's complication was corrected surgically with robotic reduction of the herniated gallbladder, closure of the diaphragmatic defect, and cholecystectomy.

To our knowledge, diaphragmatic hernia causing herniation of the gallbladder has not been previously reported. Our patient's diaphragmatic defect became symptomatic after a delay of 2 years. Such a delay is common, and practitioners should be aware of delayed symptoms after ablation as early detection can improve patient outcomes.