Successful diaphragm repair following radiofrequency ablation for renal cell carcinoma: A case report

Introduction and importance: This study aimed to assess the effectiveness of surgical intervention in treating traumatic diaphragmatic rupture accompanied by pleural empyema resulting from radiofrequency ablation for renal cell carcinoma.

Case presentation: A 72-year-old female patient underwent radiofrequency ablation at our institution's urology department to address a 4-cm tumor in the left upper kidney detected during routine health screening. Subsequently, the patient experienced persistent fever from the 5th day post- procedure. Chest radiography revealed increased opacity in the left lower lung, prompting further evaluation with contrast-enhanced chest computed tomography. Examination revealed multiple loculated effusions and discernible diaphragmatic defects. Consequently, the patient was referred to the department of thoracic surgery, where an emergency surgery was performed. The surgical procedure was performed under general anesthesia the following day, revealing a 4-centimeter defect in the diaphragm along with damaged surrounding tissue and multiple loculated empyema sacs within the thoracic cavity. The intervention included excision of the empyema sacs, extensive irrigation, and reconstruction of the diaphragm using a 2-mm Gore- Tex membrane. One week postoperatively, the patient was discharged without any complications related to the procedure.

Clinical discussion: Although radiofrequency ablation is considered a relatively safe procedure with low complication rates, vigilant post-procedural monitoring is essential for detecting potentially serious complications.

Conclusion: Surgical intervention remains the preferred approach for the repair of traumatic diaphragmatic ruptures and is typically performed via thoracotomy.