Chilaiditi Syndrome Presenting as Partial Colonic Obstruction

Abstract

Chilaiditi sign is a rare incidental radiographic finding where bowel is interposed between the diaphragm and the liver, often seen as air under the right hemidiaphragm. A majority of patients with Chilaiditi sign are asymptomatic and remain so throughout their lifetime. Chilaiditi sign is recategorized as Chilaiditi syndrome if it becomes symptomatic and is a very rare etiology of bowel obstruction. As bowel obstruction confers a huge financial burden to the health care system, studies of even the rarer etiologies are of significant value. Particularly in the case of Chilaiditi syndrome, the free air under the right hemidiaphragm can lead physicians to prematurely conclude pneumoperitoneum, which would require an emergent surgical evaluation. It is through the incorporation of a broad differential and clinical presentation that physicians can decrease the inappropriate allocation of hospital resources and unnecessary surgical procedures; additionally, keeping Chilaiditi syndrome on the differential may prevent unnecessary surgical intervention, cost to the patient, and downstream complications. Bowel obstruction secondary to Chilaiditi syndrome is most commonly treated with conservative management including intravenous fluids, bowel rest, decompression, and laxatives. If the symptoms worsen and progress to full bowel obstruction, surgical intervention has shown great efficacy. We report a case of a 69-year-old male who presented to the emergency department for progressively worsening abdominal pain, nausea, and vomiting incidentally found to have colonic interposition with mild colonic dilatation on computed tomography (CT) imaging. The patient was diagnosed with bowel obstruction secondary to Chilaiditi syndrome and treated non-surgically with rapid recovery.

Intensive Care Management of an Adult Patient With Rare Chilaiditi Syndrome Presenting as Abdominal Breathing: A Case Report

“…However, a second radiograph with positional alterations should show air movement if air has instead accumulated in the peritoneal cavity. CT can be used to confirm anything in question [ 4 ]. Similarly, for the situation we presented in this report, abdominal CT showed that there was a colon interposition between the liver and the diaphragm.…”

Biliary Obstruction Secondary to Chilaiditi Syndrome

“…1 This can often be misinterpreted as pneumoperitoneum and subsequently lead to unwarranted emergent surgical interventions. Management of CS rests largely on conservative measures including intravenous hydration, bowel decompression, and cleansing 2 , 3 while surgery is reserved for refractory/recurrent or complicated cases. Potential complications include intestinal obstruction, bowel perforation or ischemia, colonic volvulus, and subphrenic appendicitis.…”

Primary abdominal cocoon syndrome manifesting with Chilaiditi syndrome and intestinal obstruction: A case report

“…Chilaiditi syndrome also is an unusual condition characterized by colon interposition and many factors including congenital malposition, functional disease, and intra‐abdominal procedures may contribute in development of this syndrome 7 . Both ACS and Chilaiditi syndrome are rare causes of obstruction with unknown etiology 2,8 . Since ACS has a mortality rate of 50% and clinical diagnosis is mostly delayed, having high clinical suspicion and awareness of disease manifestations is needed for improving outcomes 9 .…”

“…7 Both ACS and Chilaiditi syndrome are rare causes of obstruction with unknown etiology. 2 , 8 Since ACS has a mortality rate of 50% and clinical diagnosis is mostly delayed, having high clinical suspicion and awareness of disease manifestations is needed for improving outcomes. 9 Herein we report the clinical course of an uncommon idiopathic ACS associated with Chilaiditi syndrome presented with obstruction.…”