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

Abstract

Chilaiditi syndrome is an unusual condition in which radiographic evidence of a large bowel interposition between the liver and the right hemidiaphragm appears in the chest X-ray. The etiology is unknown and the clinical symptoms vary from case to case. The special characteristics of the syndrome can easily lead to a misdiagnosis and a CT scan is needed to avoid surgical interventions for a suspected pneumoperitoneum. We present a 48-year-old female patient with a medical history of autonomic nervous system dysfunction who referred to the Emergency Department (ED) due to abdominal pain. Chest radiography revealed a radiographic sign of pneumoperitoneum but a CT scan of the abdomen showed interposition of the right colon in the right hemithorax between the diaphragm and the liver without any signs of perforation. The patient was treated with bowel decompression and her symptoms resolved gradually. So far, there is no other case of Chilaiditi syndrome in a patient with autonomic nervous system dysfunction in the published literature. To conclude, Chilaiditi's sign is an unusual radiographic sign presenting as a pneumoperitoneum in the chest X-ray. In order to avoid misdiagnosis and unnecessary surgical interventions, a CT scan should be ordered.

Chilaiditi syndrome in COPD patient: A case report

“…The estimated incidence of Chilaiditi syndrome ranges from 0.025% to 0.28% [6] . Notably, Chilaiditi syndrome predominantly affects males and typically presents with a median onset age of 60 years [7] .…”

Surgical management of large bowel obstruction and significant hepatic displacement caused by Chilaiditi syndrome

“…Chilaiditi syndrome is a rare entity in which abdominal pain or bowel obstruction is caused by interposition of the colon between the inferior surface of the right hemidiaphragm and the superior surface of the liver 1 2. The estimated incidence is 0.025% to 0.28% and it appears more frequently in men with a median age of 60 3–6. Diagnosis of the disease is primarily made by imaging, with CT being the modality of choice.…”