Chilaiditi syndrome: an unusual presentation in elderly man

Abstract

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.

An Atypical Case of Chilaiditi Syndrome

“…Demetrius Chilaiditi in 1910 first described a series of three cases with interposition of the colon or small intestine between the liver and hemidiaphragm, a finding now called Chilaiditi's sign [1]. Risk factors include liver or colon abnormalities such as increased colonic mobility, chronic constipation, lax suspensory ligaments or complications of post-procedural interventions [2,3]. Chilaiditi syndrome is a manifestation of symptoms in addition to Chilaiditi's sign.…”

“…Treatment is usually conservative and includes bowel rest, intravenous fluids, nasogastric tube decompression, and laxatives. If conservative measures fail, there may be need for surgical intervention that could range from simple measures such as colonoscopic reduction to complex surgeries such as colonic resection [2]. Overall, considering Chilaiditi syndrome in patients with potential discordance in clinical symptomatology, radiological evidence, and rapid conservative treatment of this condition can lead to a significant change in hospital course.…”

Chilaiditi Syndrome With a Large Colonic Loop in a Patient With Autonomic Nervous System Dysfunction

“…Chilaiditi syndrome is a rare medical condition in which there is radiographic evidence of a large bowel interposition between the liver and the right hemidiaphragm [1][2][3][4][5]. The estimated incidence of Chilaiditi's sign ranges from 0.025% to 0.28% and appears more frequently in men with a median age of 60 [1][2][3][4][5][6]. It can be congenital or it can be developed in patients with obesity, liver cirrhosis, or right diaphragm paralysis [1][2][3].…”

“…The estimated incidence of Chilaiditi's sign ranges from 0.025% to 0.28% and appears more frequently in men with a median age of 60 [1][2][3][4][5][6]. It can be congenital or it can be developed in patients with obesity, liver cirrhosis, or right diaphragm paralysis [1][2][3]. The colonic interposition results in various clinical manifestations [1][2][3][4].…”

“…It can be congenital or it can be developed in patients with obesity, liver cirrhosis, or right diaphragm paralysis [1][2][3]. The colonic interposition results in various clinical manifestations [1][2][3][4]. It can be asymptomatic or symptomatic causing abdominal or chest pain, nausea and vomiting, bloating and constipation [1][2][3][4].…”