Diaphragmatic hernia after cryoablation for lung cancer: a case report and literature review

Abstract

Diaphragmatic hernia can be classified into congenital and acquired subtypes, while the acquired form remains clinically rare. Iatrogenic diaphragmatic hernia, a distinct subtype of acquired diaphragmatic hernia, may occur following invasive procedures involving organs adjacent to the diaphragm. We present a 50-year-old man who developed a left-sided diaphragmatic hernia five months after cryoablation of a left lung tumor. To our knowledge, this case represents the first reported case of diaphragmatic hernia after pulmonary tumor cryoablation. The patient presented to the emergency department with acute upper abdominal pain and vomiting. Computed tomography (CT) revealed a left diaphragmatic defect with herniation of the gastric fundus. The patient underwent emergency laparoscopic diaphragmatic hernia repair with a non-absorbable mesh on the day of admission and was discharged on postoperative day 4. Delayed diaphragmatic hernia may occur after cryoablation of pulmonary lesions adjacent to the diaphragm, even when cryoablation is selected as a risk-reduction strategy. In the present case, close proximity between the ice-ball and the diaphragm, absence of protective separation, and patient-specific factors may have contributed, although the causal relationship remains uncertain. This case suggests that cryoablation should not be assumed to prevent delayed diaphragmatic hernia. For lesions near the diaphragm, protective separation techniques described in the ablation literature, including artificial ascites, artificial pleural effusion, and artificial pneumothorax, may be considered when clinically feasible.