Gut Entrapped in the Thorax: A Rare Presentation of Abdominal Pain in Chilaiditi Syndrome

Abstract

Chilaiditi syndrome is a rare disorder comprising of the interposition of the gut between the diaphragm and liver. This can lead to a spectrum of gastrointestinal and respiratory presentations, primarily in the elderly population in whom the disorder is relatively more prevalent. We present a case of a 63-year-old man who presented to our setup with abdominal pain and shortness of breath and later got diagnosed with Chilaiditi syndrome. He was managed conservatively and showed complete resolution of the symptoms.

Chilaiditi syndrome: an unusual presentation in elderly man

“…Chilaiditi’s sign, firstly, observed by Cantini in 1865 then named in reference to Demetrious Chilaiditi, who reported three cases of an incidental radiological finding of large bowel interposition between the liver and right hemidiaphragm in 1910 [ 2 , 10 ]. Estimated incidence has proved the rarity of this condition that ranges from 0.025 to 0.28% worldwide with 4:1: male-to-female ratio [ 2 , 7 ].…”

“…Generally, patients are asymptomatic, but non-specific gastrointestinal symptoms such as abdominal pain, nausea, vomiting, distension and constipation can present [ 1 , 8 ]. Furthermore, other non-gastrointestinal symptoms can be encountered, such as right shoulder pain referred from diaphragmatic irritation [ 2 ].…”

“…On the other hand, late identification of Chilaiditi syndrome is a disaster as it can lead to significant consequences such as volvulus, perforation and bowel obstruction [ 9 ]. While plain abdominal radiograph may help to differentiate between true pneumoperitoneum and Chilaiditi’s sign ‘pseudo-pneumoperitoneum’ by acquiring left lateral decubitus view revealing colonic haustra under the right hemidiaphragm, CT scan is proven to be diagnostic [ 2 , 6 ].…”

“…Usually, the first line of treatment is conservative, including bed rest, IV fluids, NGT decompression and laxatives, unless the patient does not respond to initial conservative management or complications developed such as cecal volvulus, gangrene or perforation then surgical intervention is indicated [ 2 ]. Surgical intervention varies from simple colonoscopic reduction, colopexy for cecal volvulus to colonic resection if gangrene or perforation presents [ 2 ].…”

“…Unexpectedly, in this case, the patient did not seem to have any of the previously mentioned risk factors or causes. Therefore, this raises the concern for an incidental finding of Chilaiditi signs in older patients with unremarkable predisposing factors for such finding [ 2 , 9 ].…”