Chilaiditi Syndrome in Two Cases Presented with Respiratory Distress Symptoms

Erdem, Semiha Bahçeci; Nacaroğlu, Hikmet Tekin; Karkıner, Canan Şule Ünsal; Alper, Hüdaver; Can, Demet

doi:10.5152/ttd.2014.4063

Cited by 6 publications

(7 citation statements)

References 7 publications

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“…Conservative treatment is regarded as the initial treatment of choice for patients with Chilaiditi syndrome. Conservative treatment includes bed rest, laxatives, decompression, and parenteral fluid therapy [ 7 ]. Surgical treatment is warranted in individuals with signs of bowel obstruction or ischemia, as well as in patients with recurrent Chilaiditi syndrome [ 2 ].…”

Section: Discussionmentioning

confidence: 99%

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A Rare Presentation of Pseudo-Pneumoperitoneum Secondary to Chilaiditi Sign and Chilaiditi Syndrome in Two Pre-adolescent Females: A Case Series

Vazquez,

Jones,

Ishikawa

et al. 2023

Cureus

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Chilaiditi sign is defined as the interposition of the colon or small intestine between the liver and the right diaphragm in the absence of symptoms. Chilaiditi syndrome refers to the condition where the Chilaiditi sign is associated with symptoms including abdominal pain. In this series, we present the cases of two pre-pubescent patients with these rare conditions. A 10-year-old female with a history of autism, IgA deficiency, and constipation presented for gastrointestinal studies due to weight loss and constipation. An abdominal X-ray revealed bowel gas under the right hemidiaphragm and colonic interposition between the diaphragm and the liver, raising concerns for the Chilaiditi sign. She underwent a bowel cleanout, with studies revealing colonic dysmotility and compartmentalization of the sigmoid colon and rectum with the absence of coloanal reflex. A nine-year-old female with a history of constipation, developmental delay, and hypotonia presented with abdominal pain, vomiting, constipation, and decreased appetite. She also manifested tachypnea, abdominal distension, and abdominal tenderness, with an abdominal X-ray revealing a dilated colon interposed between the liver and diaphragm, confirming Chilaiditi syndrome. Prior gastrointestinal studies showed dilated and redundant sigmoid colon and dyssynergia. The treatment entailed rectal irrigations and catheter decompression, which led to the improvement of symptoms. Conservative treatment is the treatment of choice for patients with Chilaiditi sign or Chilaiditi syndrome. It is important to distinguish Chilaiditi syndrome, a common cause of pseudo-pneumoperitoneum, from true pneumoperitoneum, as this diagnosis warrants immediate surgical intervention. Surgical treatment is indicated when there are signs of bowel obstruction or ischemia and for cases with recurrent Chilaiditi syndrome. Raising awareness about this condition is important to reduce the incidence of misdiagnosed surgical emergencies and resulting exploratory surgeries, as well as to avoid high-risk colonoscopies. Chilaiditi sign and Chilaiditi syndrome are relatively uncommon entities, and their prevalence is very rare in the pediatric population. Hence, we believe this case series will contribute to providing clinical awareness of these major complications and avoiding invasive interventions due to the inaccurate diagnosis of these conditions as pneumoperitoneum.

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Section: Discussionmentioning

confidence: 99%

“…Surgical treatment typically consists of pinning the colon to the peritoneum, typically at the level of the umbilicus. Colonoscopy during initial examination or treatment is not recommended as there is a high risk of bowel perforation [ 7 ].…”

Section: Discussionmentioning

confidence: 99%

A Rare Presentation of Pseudo-Pneumoperitoneum Secondary to Chilaiditi Sign and Chilaiditi Syndrome in Two Pre-adolescent Females: A Case Series

Vazquez,

Jones,

Ishikawa

et al. 2023

Cureus

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“…The etiology of Chilaiditi syndrome has been categorized into (1) Intestinal: megacolon, abnormal colonic motility or redundancy, constipation, and congenital malrotation; (2) Hepatic: cirrhosis, segmental agenesis of the right lobe of the liver, and relaxation of the hepatic suspensory ligament; and (3) Diaphragmatic: phrenic nerve injury and diaphragmatic eventration[ 15 , 17 ]. Several risk and predisposing factors have been associated with this entity including, aerophagia, adhesions, obesity, constipation, mental retardation, pregnancy, muscular dystrophy, and significant weight loss[ 17 , 22 ].…”

Section: Discussionmentioning

confidence: 99%

Chilaiditi syndrome in pediatric patients - Symptomatic hepatodiaphragmatic interposition of colon: A case report and review of literature

Caicedo¹,

Wasuwanich²,

Rivera³

et al. 2021

WJCP

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BACKGROUND Chilaiditi syndrome is a rare disorder characterized by the hepatodiaphragmatic interposition of the intestine. CASE SUMMARY Here we report a case of a 12-year-old male who was admitted to the pediatric intensive care unit secondary to abdominal pain and severe respiratory distress. He was treated conservatively but the symptoms persisted requiring a surgical approach. While there have been several cases of Chilaiditi syndrome reported in adults, there is a scarcity of cases reported in the pediatric population. Our review of the literature found only 30 pediatric cases, including our reported case, with Chilaiditi syndrome, 19 (63%) of which were male. The median age of diagnosis was 4.5 years old with an interquartile range of 2.0-10.0 years. In our review, we found that the most common predisposing factors in children are aerophagia (12/30 cases) and constipation (13/30 cases). Ninety percent of the cases presented with complete intestinal interposition, in 100% of which, the colon was involved. Three of the 30 cases were associated with volvulus. CONCLUSION In the pediatric population, conservative (21/30 cases) and surgical (8/30 cases) treatment approaches have produced satisfactory outcomes for all the patients, regardless of approach.

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“…Chilaiditi's sign is defined as the radiographic evidence of colonic interposition between the liver and the diaphragm or abdominal wall. Its frequency ranges between 0.25% and 0.28% and increases with age [2]. Differential diagnoses include pneumoperitoneum, diaphragmatic hernia, volvulus, intussusceptions, and ischemic bowel [3].…”

Section: Discussionmentioning

confidence: 99%

“…Chilaiditi's sign was first defined in 1910 by the Greek radiologist Demetrius Chilaiditi in three asymptomatic cases. It usually presents as an incidental radiological finding in the context of investigations for other disorders [2].…”

Section: Introductionmentioning

confidence: 99%

A rare radiological finding in an infant with respiratory distress

2018

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We report the case of an infant who presented with respiratory distress at the Emergency Department. A chest radiograph showed interposition of colon loops between the right hemidiaphragm and liver, while abdominal and thoracic ultrasound examinations were normal. The aforementioned radiological finding was considered to be Chilaiditi's sign. This sign usually presents as an incidental radiological finding and may be mistaken for a pneumoperitoneum or a diaphragmatic hernia. Clinicians' familiarity with rare radiological signs is necessary.

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Chilaiditi Syndrome in Two Cases Presented with Respiratory Distress Symptoms

Cited by 6 publications

References 7 publications

A Rare Presentation of Pseudo-Pneumoperitoneum Secondary to Chilaiditi Sign and Chilaiditi Syndrome in Two Pre-adolescent Females: A Case Series

A Rare Presentation of Pseudo-Pneumoperitoneum Secondary to Chilaiditi Sign and Chilaiditi Syndrome in Two Pre-adolescent Females: A Case Series

Chilaiditi syndrome in pediatric patients - Symptomatic hepatodiaphragmatic interposition of colon: A case report and review of literature

A rare radiological finding in an infant with respiratory distress

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