The combination of Chilaiditi syndrome and Bochdalek hernia in an adult: successful management with a robot assisted approach

Abstract

The combination of Chilaiditi syndrome and Bochdalek hernia in an adult: successful management with a robot assisted approach A 57-year-old female presented with 1 week of sudden onset generalized abdominal pain, obstructive symptoms and progressive dyspnea on exertion. Examination revealed abdominal distension with guarding and tenderness in the right upper quadrant. Vital signs and bloods were normal.Computed tomography (CT) with oral and intravenous contrast of the abdomen and pelvis demonstrated herniation of the right liver and large bowel into the right anterior thoracic cavity above the diaphragm consistent with a Bochdalek Hernia (BH) (Fig. 1). The hernial neck measured 62 mm. There was interposition of sigmoid colon above the liver consistent with Chilaiditi syndrome (ChS) with associated stranding and free fluid suggestive of incarceration. No pneumoperitoneum or pneumatosis was visualized.Given the acute signs and incarceration of the bowel, the decision was made for surgical repair. A multidisciplinary approach with colorectal and cardiothoracic surgery using a robotic platform Fig. 1. Coronal and axial CT image demonstrating intrathoracic displacement of the liver as well as interposition of the above the liver with associated stranding. (a) The arrow shows colon interposition above the liver, the star shows faecal loading of the caecum. (b) The arrow demonstrates stranding of the colon. (c) The diaphragm is shown in red and herniation of the liver and colon through the diaphragmatic defect can be seen. (d) The hernia neck is measured 62 mm (white arrow). (e) Intrathoracic displacement of liver and colon is visualized and stranding of the colon and associated free fluid (star) suggests incarceration.

Unveiling the Chilaiditi Syndrome: A Case Report and Management Implications

“…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].…”

Delayed Right Diaphragmatic Hernia With Chilaiditi Syndrome: A Case Report

“…The presentation of Chilaiditi syndrome varies from constipation to marked chest pain [5][6][7]. Conservative management with a nasogastric tube, bowel rest, and fluid resuscitation is appropriate for the majority of patients, while up to one-fourth of patients may require surgical intervention [7][8][9]. Therefore, Chilaiditi Syndrome is an important differential diagnosis when radiological studies reveal pneumoperitoneum.…”