Chilaiditi's syndrome

Abstract

Chilaiditi's syndrome should be considered in the differential diagnosis of abdominal and chest pain. Although interposition of the right colon is a relatively common radiologic finding, there is a distinct paucity of information in the medical literature. Chilaiditi's syndrome is usually asymptomatic, but when symptoms occur, conservative treatment is usually effective. Recognition is important because this syndrome can be mistaken for more serious abnormalities, which may lead to unnecessary surgical intervention.

Clinical Quiz

“…Chilaiditi's syndrome is the term reserved for patients with the typical radiologic findings who also have symptoms, such as pain or vomiting. Chilaiditi's sign is more common in men (male‐female ratio = 4:1), and it is often seen in mentally retarded persons (8.8%); it is an uncommon finding in children (2,3).…”

“…Displacement of the colon is anterior and superior to the liver (2). Interposition can be facilitated by inferior displacement of the liver by a reduction of liver volume (as in cirrhosis) and by congenital laxity of the hepatic suspensory ligaments.…”

“…Recognition of Chilaiditi's sign is important because its radiographic findings can be confused with pneumoperitoneum, subphrenic abscess, ruptured abdominal viscus, posterior hepatic lesions, or retroperitoneal masses (2,3). The most common of these are pneumoperitoneum and subphrenic abscess.…”

“…Chilaiditi's syndrome can have a variety of clinical presentations. The most common are nausea, vomiting, diaphoresis, anorexia, constipation, and right upper quadrant or epigastric abdominal pain (2–4). It can also present with flatulence, change in bowel habit, intermittent intestinal obstruction, respiratory distress, and cardiac arrhythmias.…”

“…Less commonly, interposition has been associated with severe complications such as internal hernias, volvulus of the colon, acute intestinal obstruction, and subphrenic appendicitis. Treatment of Chilaiditi's syndrome is almost always conservative and consists of bedrest in the supine position, fluid supplementation, nasogastric decompression, enemas, cathartics, high‐fiber diets and stool softeners (2–4). In the more unusual cases, such as those with colonic volvulus, surgical intervention may be required.…”