Repair of Large Diaphragmatic Defect Using Artificial Patch in Hydatid Disease

2831 Correspondence To the Editor: Hydatid is an endemic zoonosis disease which brings great harm to the human. It is popular in developing countries especially in North Western China where animal husbandry is the primary industry. For liver hydatid, a few cases may be associated with diaphragmatic muscle invasion, and even invasion into the chest and the right lung, which become more difficult in clinical treatment. In a recent clinical work, a 64‑year‑old local female farmer was admitted with pain in the right upper quadrant abdomen ongoing for 1‑year. Computed tomography confirmed that there was a cystic neoplasm in the right posterior of the liver with a size about 10 cm × 7 cm × 7 cm, which had clear bounder, closely related to the diaphragmatic muscle [Figure 1a‑c]. During surgery, the mass could not be separated from the right side of the diaphragmatic muscle [Figure 1d]. In order to completely resect the mass, we were forced to remove the invaded diaphragmatic muscle which has been totally occupied by the hydatid disease, and repair the diaphragmatic muscle with abdominal patch (UML1, 30 cm × 30 cm, from Johnson and Johnson, USA) [Figure 1f‑h]. The pathologic diagnosis was confirmed as hydatid [Figure 1d]. The patient had a smooth postoperative course. Through the literature review, we found that liver hydatid cysts can rupture into neighboring structures in 15–60% of patients, [1] and most often involves the bile duct, the bronchi, and the peritoneal cavities. Rarely, the involvement of the chest or abdominal wall after liver cysts rupture, which may be challenging to manage. Most of the authors [2‑5] have reported some treatment principles or operation methods about the liver hydatid associated with diaphragm or lung invaded. But no article has elaborated how to deal with the invaded and incomplete diaphragm muscle if the patient has a significant defect located in the diaphragm. According to our experience, liver hydatid disease, especially near the surface of the liver, is often accompanied by the diaphragm muscle invasion, or even resulted in pulmonary hydatid. If the hydatid invaded into the chest through the diaphragmatic muscle, the clearance can not be found between the capsule and diaphragm. Part of the diaphragmatic muscle must be removed if we decide to remove the liver hydatid. For smaller diaphragmatic muscle defect (diameter of 5 cm and below), suturing and closing it directly is the best approach. While for a larger …