Chilaiditi syndrome is a rare condition when pain occurs due to transposition of a loop of large intestine (usually transverse colon) in between the diaphragm. Chilaiditi syndrome is the anterior interposition of the colon to the liver reaching the under-surface of the right hemidiaphragm with associated upper abdominal. Chilaiditi syndrome is a rare condition occurring in % to % of the population. In these patients, the colon is displaced and caught.

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Chilaiditi syndrome

An elderly man with chest pain, shortness of breath, and constipation. Surgery is rarely indicated with indications including chilaifiti and failure of resolution with conservative management.

However, variations in normal anatomy can lead to the pathologic interposition of the colon. Mental retardation and schizophrenia are also associated with anatomic abnormalities that synddome in Chilaiditi sign. Coeliac Tropical sprue Blind loop syndrome Small bowel bacterial overgrowth syndrome Whipple’s Short bowel syndrome Steatorrhea Milroy disease Bile acid malabsorption.

Diagnosis is best achieved with CT imaging. Lekkas CN, Lentino W. About News Events Contact. View large Download slide.

Intensivists referred him to General surgery as they detected a suspicious presence of gas under the diaphragm pneumoperitoneum. An interposed segment of bowel can also make it very diffcult to perform a potentially dangerous complication that can lead to perforation [ 5 ].

Combined physical examinations and detailed imaging survey could be useful in making the correct diagnosis and avoiding unnecessary operation. Symptom-producing interposition of the colon. Chilaiditi syndrome associated with transverse colon volvulus: In these patients, the colon is displaced and caught between the liver and the right hemidiaphragm.

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Chilaiditi’s Syndrome – NORD (National Organization for Rare Disorders)

Investigational Therapies IInformation on current clinical trials is posted on the Internet at www. Sydrome syndrome Colonic interposition. Dyspnea and large bowel obstruction: Melester T, Burt ME. For the diagnosis to be made by imaging, the right hemidiaphragm must be displaced superiorly to the liver by the intestines, pseudoperitoneum caused by air in the bowels must be seen, and the superior aspect of the liver must be positioned below the level of the left hemidiaphragm.

No signs of rebound tenderness, guarding, or ascites were observed. In summary, abdominal pain with subphrenic free air does not always indicate surgical emergency.

Posteroanterior chest radiography revealed the presence of air below the right side of the diaphragm Figure 1a. He is a non-smoker, non-alcoholic and does not use any abusive drugs. In general, just as in our case, after conservative treatment, the symptoms may subside and urgent surgery is unnecessary. In rare cases, symptoms do develop; these cases are referred to as Chilaiditi’s syndrome.

Case Reports in Surgery

Chilaiditi syndrome should be considered as a rare cause of intestinal obstruction of either the large or small bowel, as reported by Mateo de Acosta Andino and associates. The finding revealed transverse colon interposition between liver and right diaphragm Figure 1b. A repeat radiograph following bowel decompression may show disappearance of the air below the diaphragm.

The removal of pressure from the intestines bowl decompression has alleviated symptoms in some cases. By using this site, you agree to the Terms of Use and Privacy Policy. The patient underwent exploratory video-assisted thoracoscopic surgery where it was discovered there had been no injury to the diaphragm or any other organs despite the strong clinical suspicion.


A hepatic panel was within normal limits. Surgical techniques that have been used to treat individuals with Chilaiditi’s syndrome include the removal of a portion of the colon transverse colectomy or right hemicolectomy or the anchoring of a displaced liver to the abdominal wall hepatopexy.

The right hemidiaphragm must be adequately elevated above the liver by the intestine, the bowel must be distended by air to illustrate pseudopneumoperitoneum, and the superior margin of the liver must be depressed below the level of the left hemidiaphragm.

In this case, the gallbladder position is often anomalous as well — it is often located anterior to the liver, rather than posterior. Local examination of respiratory, cardiac system revealed nothing significant. Eponymous medical signs for digestive system and abdomen. To diagnose Chilaiditi sign based upon radiologic findings, chi,aiditi following criteria must be met: Chilaiditi syndrome Chest X-ray showing obvious Chilaiditi’s sign, or presence of gas in the right colic angle between the liver and right hemidiaphragm.

The diaphragm is the muscle that separates the chest cavity from the abdomen. Chilaiditi’s sign is generally not associated with symptoms, and is most commonly an incidental finding in normal individuals. Some affected individuals may not require any therapy.

CT can clearly demonstrate the presence of interposed colonic loops between the right hemidiaphragm and liver with no free intraperitoneal air.

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