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

Abstract

Chilaiditi’s sign is the presence of pseudopneumoperitoneum caused by colonic distension and interposition with the liver on radiographic films. Most patients with Chilaiditi’s sign are asymptomatic. Chilaiditi’s syndrome is defined as the development of abdominal pain or symptoms of bowel obstruction along with the presence of Chilaiditi’s sign. It is a rare entity and it poses significant diagnostic challenges due to its similar radiographic appearance to pneumoperitoneum. Most patients with Chilaiditi syndrome can be managed conservatively. However, surgery is indicated for those who do not respond to conservative management or for suspicion of severe complications such as bowel ischaemia or perforation. In this case report, we described the surgical management of a patient who presented with bowel obstruction and significant hepatic displacement from Chilaiditi syndrome.

Unveiling the Chilaiditi Syndrome: A Case Report and Management Implications

“…The Chilaiditi syndrome has a diverse presentation, including respiratory distress and angina-like episodes [6]. The appropriate treatment therefore considers symptom severity, with critical manifestations such as those complicated by bowel obstruction prompting surgical intervention [13]. The chronicity and frequency of associated symptoms also have a role in dictating management.…”

“…Meanwhile, for severe cases, additional workup could include Gastrografin enemas, CT with endoluminal contrast, and colonoscopy [14]. Reported successful surgical interventions for these instances include total or partial colonic resection combined with hepatopexy [6,13]. Some patients have even required diaphragmatic intervention [16,17].…”