Colonic interposition between the liver and left diaphragm - management of Chilaiditi syndrome: A case report and literature review

Abstract

Chilaiditi syndrome refers to a medical condition that is indicated by the presence of Chilaiditi sign, the radiological observation of a colonic interposition between the liver and the diaphragm, and is associated with other clinical symptoms. Chilaiditi syndrome is a rare entity and therefore, is often misdiagnosed in clinical practice, however, it may be accompanied by a series of severe complications, such as bowel obstruction and perforation. The current study describes a 47-year-old male who presented with repeated abdominal pain and acute intestinal obstruction. The patient was diagnosed with Chilaiditi syndrome via radiological observation and was cured by conservative treatment. The clinical data of seven additional patients with Chilaiditi syndrome, which was reported in the Chinese literature between January 1990 and January 2013, were also collected. The pathogenesis, clinical manifestation, diagnosis and treatment of this syndrome have been reviewed and analyzed. The current study may be useful to familiarize clinical practitioners with Chilaiditi syndrome, in order to avoid a misdiagnosis during clinical treatment.

Incidental finding of Chilaiditi’s sign in an elderly individual with sarcopenia

“…Small bowel involvement such as in our patient is even less common, accounting for 3-5 % of cases [3]. Despite the rarity of small bowel interposition, Fig.…”

“…Radiographic detection of Chilaiditi's sign is rare with an estimated prevalence of 0.028-0.25 %; it is four times more likely to be observed in men, and increases with age [3]. Small bowel involvement such as in our patient is even less common, accounting for 3-5 % of cases [3].…”

“…Although the bowel haustra and plicae circulares are clearly evident in our radiographs, in instances where there is less bowel insufflation, the crescentic radiolucency overlying the liver can give the impression of free air under the diaphragm or a subphrenic abscess, potentially resulting in unnecessary surgical intervention [3][4][5]. Computed tomography is the imaging of choice for the hemodynamically stable patient in this situation [4,5].…”

“…Among trauma patients, diaphragmatic herniation and hemidiaphragmatic eventration with paralysis secondary to phrenic nerve damage should be considered [2]. Congenital and acquired medical conditions can further predispose patients, and the presence of Chilaiditi's sign warrants clinical correlation with possible underlying causes such as hepatic lobe agenesis, cirrhosis and ascites, morbid obesity, cachexia, and obstructive pulmonary diseases, which widen the lower thoracic diameter [2][3][4].…”

Chilaiditi’s Syndrome Complicated by Colon Perforation: A Case Report

“…[1,2] It is incidentally seen 0.025-0.28% in the general population. [3] Its incidence increases with advancing age and it is seen rarer in children when compared to adults.…”