Acute Epigastric Pain with History of HCC and Multiple RFA: What Could Be the Cause?

Case presentation An 80-year-old female presented with acute epigastric pain that was sudden in onset and intense in severity. There was no history of trauma. Medical history H/o hepatitis C-related liver cirrhosis and hepatocellular carcinoma (HCC) in segment 6 Treatment details – Follow-up CT (21 months ago) – No recurrence of HCC Table 1.

Different examinations at the time of presentation and their respective findings. *NAD – No abnormality detected, CRP – C-reactive protein   Treatment plan: Laparoscopic surgery under general anesthesia; pneumoperitoneum creation by carbon dioxide insufflation in the epigastric region using the open Hasson technique. Laparoscopic observations (cover images): Small intestine herniation through the diaphragmatic defect (Cover image A) Ischemic change and partial necrosis of the small intestine No fragility around the hernia orifice (Cover image…