Chilaiditi syndrome is a radiological manifestation of a large bowel interposition between the liver and right hemidiaphragm that associated with gastrointestinal symptoms. We report a case of 78-year-old Saudi male with multiple comorbidities, presented to the emergency department with two episodes of passaging a large amount of fresh, bright blood per rectum. Later, the patient was diagnosed with Chilaiditi syndrome and managed with conservative measures. The presence of Chilaiditi signs can be caused by an abnormality of either liver, colon or right hemidiaphragm that leads to sub-diaphragmatic space enlargement or intestinal hypermobility. Computed tomography imaging is the best diagnostic modality. Conservative treatment is the first line in management.

Highlights Gallbladder carcinosarcoma is a rare cancer with a worldwide prevalence of less than 1%. The pathogenesis of these tumors is not yet fully understood, due to the low incidence of these tumors. Only 30% are suspected pre-operatively. The prognosis of these tumors is poor even after complete resection with a survival rate range from 2.9 to 6 months.