We report a case of incarcerated diaphragmatic hernia as a late complication of radiofrequency ablation (RFA). Diaphragmatic hernia is a late complication of RFA, and only few cases of incarcerated ...diaphragmatic hernia have been reported. Here we present the case of a man in his late sixties hospitalized for constipation, abdominal pain, and fever. The patient had undergone RFA for persistent hepatocellular carcinoma on 20 occasions at another hospital. Computed tomography revealed a prolapsed large intestine through a defect on the right diaphragm; therefore, an emergency surgery was performed. The size of the hernia orifice was 3.5 × 2.5 cm, and the transverse colon and greater omentum had prolapsed and adhered to the hernia gate. Adhesiolysis and reduction of the incarcerated transverse colon and greater omentum were performed. The hernia orifice was sutured and reinforced with a composite mesh. Diaphragmatic hernias following RFA may result in strangulation of hernia and are associated with poor prognosis. Appropriate surgical intervention may be necessary to treat incarcerated diaphragmatic hernia.
•Contraceptive pill induced hepatocellular adenoma with Turner’s syndrome patient is extremely rare.•However Turner’s syndrome patient requires a lifetime hormone replacement therapy.•Proper ...diagnosis and treatment plan is necessary for hepatocellular adenoma.
Hepatocellular adenoma (HCA) is a rare benign tumor and is related to the use of an oral contraceptive pill. Turner’s syndrome requires various hormone replacement therapies, including the pill which is used as a female hormone replacement therapy. Herein we report a case of Turner’s syndrome with HCA treated by liver segmentectomy.
A 36-year-old woman with Turner’s syndrome was treated with oral contraceptive pills as a female hormone replacement therapy for 20 years. She presented with fatigue and liver tumor. Liver tumors in the posterior lobe measuring 60 mm and 10 mm in diameter were detected on CT; hence, she was referred to our department. Both the tumors showed high intensity in the arterial phase, iso-intensity in the portal and late phases, and low intensity in the hepatobiliary phase on Gb-EOB-MRI. She was diagnosed with multiple HCAs and underwent segmentectomy Section 7. Pathologically, both the tumors were diagnosed as HCAs, and inflammatory markers were detected by immunohistochemistry. Thirteen months postoperatively, she was doing well and there was no evidence of recurrence of HCA without the pill.
There is only one report of HCA in patients with TS (Espat et al., 2000). We reported a case of multiple HCAs in a patient with TS underwent hepatectomy.
With the use of the contraceptive pill as a long-term female hormone replacement therapy for Turner’s syndrome, careful attention is required for HCA.
A 73-year-old man with rectal cancer was admitted to our hospital with a complaint of blood in his stool. Colonoscopy revealed a type 2 tumor in the lower rectum. Upper gastrointestinal endoscopy ...found a 0-Ⅱc lesion at the greater and lesser curvatures of the gastric body and a 0-Ⅱb lesion at the lesser curvature. Therefore, based on the diagnosis of gastric and rectal cancer, we performed simultaneous laparoscopy-assisted combined resection for both gastric and rectal cancer.Based on the diagnosis of the rectal cancer T4a, N1, M0 Stage Ⅲa, we administered NACRT. A complete response was almost achieved following NACRT. We performed the surgery after completion of NACRT.First, laparoscopic distal gastrectomy (delta anastomosis) was performed because of the necessity to determine the port positions. Next, we performed laparoscopic abdominoperineal resection after insertion of the additional ports. In this case, it was possible to extract a specimen through the perineum incision. We simultaneously performed simultaneous laparoscopic surgery for gastric and rectal carcinoma with only one incision.
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