The Trans-Diaphragmatic Hydatid Cyst: An Unconventional Surgical Strategy

Abstract

Introduction: The hydatid disease is a zoonotic infection due to the tapeworm echinococcus granulosus (TEG). In 50-70% of the cases, the hydatid cyst is observed with a hepatic localization. The trans-diaphragmatic extension of a liver hydatid cyst is rarely reported in the literature. Here, we report the singularity of our observation which focuses on-an abdominal approach rather than a thoracotomy and the way we handle the diaphragmatic defect.

Observation: A 34-year-old male patient presented with a right hypochondriac pain evolving since 2 years. The abdominal examination found a bulging just below the right costal margin. The ultrasound and computed tomography (CT) scan images show an enormous liver hydatid cyst covering the entire posterior right section and extending beyond the diaphragm to the right hemi-thorax. Our therapeutic strategy consisted of a resection of the protruding dome with aspiration and evacuation of all the hydatid material. We did not close the diaphragmatic defect because there was no communication with the thorax contents. Our management had no negative impact on the patient in 2 years of follow-up.
Conclusion: Being rarely reported in the literature, the trans-diaphragmatic hydatid cyst is an uncommon situation. The surgical intervention is the main stay treatment. Our management of the diaphragmatic defect was unconventional. The singularity of our approach is to not close the diaphragmatic defect since we considered the remaining fibrous capsule as a closure, avoiding a laborious dissection and a complex diaphragmatic reconstruction.