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Kamel I, Yalcin Y, Ponder R, Elkhawas I, Solangi Z. Unveiling the Chilaiditi Syndrome: A Case Report and Management Implications. Cureus 2024; 16:e57483. [PMID: 38707147 PMCID: PMC11065776 DOI: 10.7759/cureus.57483] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/02/2024] [Indexed: 05/07/2024] Open
Abstract
The Chilaiditi syndrome is when the radiologic Chilaiditi sign, defined by the interpositioning of the colon between the liver and diaphragm, becomes complicated by clinical symptoms such as respiratory insufficiency or bowel obstruction. We present the case of a 70-year-old male with a history of depression, anxiety, gastroesophageal reflux disease (GERD), and post-polio syndrome, who presented with left shoulder pain, chronic weakness, and dizziness. Initial evaluation revealed hypotension and elevated lactic acid, attributed to dehydration. Further imaging identified a Chilaiditi sign, thus raising suspicion of small bowel obstruction and the Chilaiditi syndrome. Despite conservative management, the patient continued to experience elevated lactic acid levels, prompting a computed tomography (CT) angiogram to rule out bowel ischemia. No acute intra-abdominal pathology was identified, and the patient improved with hydration and bowel rest. This case highlights the challenges in diagnosing and managing the Chilaiditi syndrome in the setting of chronic comorbidities.
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Affiliation(s)
- Ibrahim Kamel
- Internal Medicine, Steward Carney Hospital, Boston, USA
| | - Yusuf Yalcin
- Radiology, Tufts University School of Medicine, Boston, USA
| | - Reid Ponder
- Radiology, Tufts University School of Medicine, Boston, USA
| | - Ibrahim Elkhawas
- Pulmonary Critical Care, Baystate Medical Center, Springfield, USA
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2
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Wahab A, Ghulam M, Anthony N, Khan I, Ullah N. A Case Report of Chilaiditi's Syndrome With Sigmoid Volvulus. Cureus 2023; 15:e46193. [PMID: 37905283 PMCID: PMC10613345 DOI: 10.7759/cureus.46193] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/29/2023] [Indexed: 11/02/2023] Open
Abstract
Chilaiditi's syndrome is the hepatodiaphragmatic interposition of the colon. It can be caused by any pathology of intestinal, hepatic, and diaphragmatic factors. Any anatomic variations or functional abnormalities can increase the development of Chilaiditi's syndrome. It is usually asymptomatic and is found indecently in radiological studies. It is treated conservatively as long as any complications do not arise. This case of Chilaiditi's syndrome was associated with sigmoid volvulus and multiple tubercles on its surface. A 35-year-old male patient presented to the outpatient department (OPD) with complaints of weight loss, bilateral flank pain, abdominal distention, decreased appetite, vomiting, and diarrhea. CT scan showed a grossly distended loop of the colon with sigmoid volvulus and Chilaiditi's sign. A laparotomy was done, sigmoid volvulus was relieved, a biopsy of tubercles was taken for histopathology, and a colostomy was done. The biopsy result showed abdominal tuberculosis. The colostomy was later reversed. Chilaiditi's syndrome is usually treated surgically because it is associated with other complications in the gastrointestinal tract. Previous studies showed the management of cases by colonic resection with primary anastomosis; however, there was one case that reported mortality due to an anastomosis leak. In this article, we present a case of Chilaiditi's syndrome associated with sigmoid volvulus and abdominal tuberculosis as seen on biopsy, which was managed surgically by colostomy followed by colostomy reversal on follow-up.
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Affiliation(s)
- Abdul Wahab
- Internal Medicine, Hayatabad Medical Complex Peshawar, Peshawar, PAK
| | - Moula Ghulam
- Medicine, Rehman Medical Institute, Peshawar, PAK
| | - Nouman Anthony
- General Medicine, Rehman Medical Institute, Peshawar, PAK
| | - Imran Khan
- Cardiothoracic Surgery, St Bartholomew's Hospital, London, GBR
| | - Najeeb Ullah
- Internal Medicine, Rehman Medical Institute, Peshawar, PAK
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Muacevic A, Adler JR, Shah S, Hussain S, Shah V, Hussain A, Ijaz HM, Rahim M. A Rare Presentation of Congenital Chilaiditi Syndrome: Symptomatic Hepatobowel Entrapment. Cureus 2023; 15:e33714. [PMID: 36788833 PMCID: PMC9922167 DOI: 10.7759/cureus.33714] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Accepted: 01/12/2023] [Indexed: 01/15/2023] Open
Abstract
The displacement and trapping of the colon between the liver and the right hemidiaphragm are known as the Chilaiditi sign or syndrome. The Chilaiditi sign presents in an asymptomatic patient, while Chilaiditi syndrome presents with symptoms such as abdominal pain, distension, and constipation, in addition to complications such as perforation, volvulus, and bowel obstruction. It is often misdiagnosed as pneumoperitoneum or free air under the diaphragm and liver, often seen on the abdomen and chest radiography. It more commonly presents in males than in females. Here, we present the case of a 37-year-old female who reported abdominal pain and persistent constipation. An abdominal CT scan showed entrapment of a bowel segment, which is referred to as the Chilaiditi sign. The patient's presentation with hepatobowel entrapment and persistent gastrointestinal symptoms was diagnosed as Chilaiditi syndrome. This presentation entails a conservative management approach. The aim of this report is to educate about the rare occurrence of Chilaiditi sign and Chilaiditi syndrome as a differential diagnosis to often misdiagnosed critical conditions such as pneumoperitoneum and intestinal perforation. Correctly identifying these patients will reduce overtreatment and help improve outcomes.
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Shah SS, Chaurasia D, Katuwal D. Dilated sigmoid colon with Chilaiditi's sign mimicking diaphragmatic hernia: A case report. Int J Surg Case Rep 2022; 97:107373. [PMID: 35816777 PMCID: PMC9283501 DOI: 10.1016/j.ijscr.2022.107373] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Revised: 06/26/2022] [Accepted: 06/26/2022] [Indexed: 02/07/2023] Open
Abstract
INTRODUCTION Chilaiditi's sign is a rare radiological presentation characterized by colonic interposition between the diaphragm and liver which is usually confused with conditions such as diaphragmatic hernia, pneumoperitoneum and subdiaphragmatic abscess. CASE PRESENTATION We report a case of 55 year old male presenting with abdominal pain since a year which was associated with abdominal fullness, loss of appetite and constipation. Further investigations showed us as a case of diaphragmatic hernia but intra operatively it was found to be Dilated sigmoid colon with Chilaiditi's sign. CLINICAL DISCUSSION It is a rare incidental finding with major preponderance in male. The intestinal, hepatic and diaphragmatic causes predispose its pathology. Conservative management is the first line of treatment but the complicated abdominal pathologies are managed by various surgical intervention. CONCLUSION Dilated sigmoid colon along with Chilaiditi's sign can sometime mimic as Diaphragmatic hernia which can make enormous difference in our pre and post-operative diagnosis. Chilaiditi's syndrome is a rare entity so early diagnosis is of utmost benefit.
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Affiliation(s)
| | | | - Dinjul Katuwal
- Department of Surgery, Janaki Medical College Teaching Hospital, Janakpur, Nepal
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Mandal S, Singh S, Ray BK, Thakur RK, Shah AK, Kolade V. Air under the diaphragm-perforation or Chilaiditi sign? Proc AMIA Symp 2022; 35:108-110. [PMID: 34970055 DOI: 10.1080/08998280.2021.1961550] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Abstract
Chilaiditi sign is a rare radiological finding in which the colon is interposed between the liver and the abdominal wall. Once patients become symptomatic, the condition is called Chilaiditi syndrome. We discuss a unique patient who presented with intermittent abdominal pain for 2 years that worsened 6 months before presentation. Her radiological evaluation revealed Chilaiditi sign. She was treated conservatively and the sign resolved. We emphasize the importance of conservative management in Chilaiditi syndrome.
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Affiliation(s)
- Shobha Mandal
- Department of Internal Medicine, Guthrie Robert Packer Hospital, Sayre, Pennsylvania
| | - Sneha Singh
- Department of Internal Medicine, Guthrie Robert Packer Hospital, Sayre, Pennsylvania
| | - Barun Kumar Ray
- Department of Internal Medicine, BP Koirala Institute of Health Sciences, Dharan, Nepal
| | | | - Anish Kumar Shah
- Department of Internal Medicine, Bronxcare Hospital, Bronx, New York
| | - Victor Kolade
- Department of Internal Medicine, Guthrie Robert Packer Hospital, Sayre, Pennsylvania
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Chilaiditi’s Sign and Cystic Artery Pseudoaneurysm Complicating Acute Cholecystitis: an Exceptional Association Detected on Computed Tomography. Indian J Surg 2021. [DOI: 10.1007/s12262-020-02641-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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Ben Ismail I, Zenaidi H, Rebii S, Yahmadi A, Zoghlami A. Chilaiditi's sign: A rare differential diagnosis of pneumoperitoneum. Clin Case Rep 2020; 8:3102-3104. [PMID: 33363889 PMCID: PMC7752635 DOI: 10.1002/ccr3.3346] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2020] [Revised: 08/14/2020] [Accepted: 08/18/2020] [Indexed: 11/29/2022] Open
Abstract
Chilaiditi sign is a rare condition typically mistaken for pneumoperitoneum. CT scan can confirm the diagnosis. Its management is conservative that is why it should be well known by surgeons to avoid unnecessary exploratory laparotomies.
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Affiliation(s)
- Imen Ben Ismail
- Department of General Surgery Trauma and Burns Center Ben Arous Tunisia
| | - Hakim Zenaidi
- Department of General Surgery Trauma and Burns Center Ben Arous Tunisia
| | - Saber Rebii
- Department of General Surgery Trauma and Burns Center Ben Arous Tunisia
| | | | - Ayoub Zoghlami
- Department of General Surgery Trauma and Burns Center Ben Arous Tunisia
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Gunji S, Katayama H, Morikawa S. Successful treatment of an iatrogenic gastro-colo-cutaneous fistula in a patient with Chilaiditi syndrome: A case report. COGENT MEDICINE 2017. [DOI: 10.1080/2331205x.2017.1331600] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Affiliation(s)
- Shutaro Gunji
- Department of Surgery, Shojukai Kyowa Hospital, Daigo Kawakubo-cho 30, Fushimi-ku, Kyoto, Japan
| | - Hokahiro Katayama
- Department of Surgery, Shojukai Kyowa Hospital, Daigo Kawakubo-cho 30, Fushimi-ku, Kyoto, Japan
| | - Shigehiro Morikawa
- Department of Surgery, Shojukai Kyowa Hospital, Daigo Kawakubo-cho 30, Fushimi-ku, Kyoto, Japan
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Fomin D, Baranauskaitė V, Laima S, Jasulaitis A, Petroška D. Death Caused by Hepatodiaphragmatic Interposition of the Colon. J Forensic Sci 2016; 62:247-249. [PMID: 27861867 DOI: 10.1111/1556-4029.13232] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2015] [Revised: 02/12/2016] [Accepted: 03/06/2016] [Indexed: 11/29/2022]
Abstract
Hepatodiaphragmatic interposition of the colon is a rare, usually asymptomatic, anomaly and is typically an incidental radiologic finding. There are few cases in the literature describing the symptomatic form of the condition, known as Chilaiditi syndrome. In some cases, it may be accompanied by various severe complications. If symptoms are present, usually conservative treatment is given. However, conservative treatment only addresses the symptoms but does not prevent their recurrence and possible complications. Our present report shows that this anomaly may not only cause symptoms, but may also progress and cause severe complications, in our case-megacolon leading to right heart failure and, ultimately, death. To date, however, there have been no literature reports of death caused by colonic interposition. Therefore, it is important to draw attention to the importance of this anomaly and its appropriate diagnosis and treatment to ensure the most favorable patient outcomes.
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Affiliation(s)
- Dmitrij Fomin
- Department of Pathology, Forensic Medicine and Pharmacology, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
| | - Vilma Baranauskaitė
- Department of Pathology, Forensic Medicine and Pharmacology, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
| | - Sigitas Laima
- Department of Pathology, Forensic Medicine and Pharmacology, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
| | - Algimantas Jasulaitis
- Department of Pathology, Forensic Medicine and Pharmacology, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
| | - Donatas Petroška
- Department of Pathology, Forensic Medicine and Pharmacology, Faculty of Medicine, Vilnius University, Vilnius, Lithuania.,National Center of Pathology, Vilnius University Hospital Santariskiu Clinics, Vilnius, Lithuania
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10
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Leung KK, Frobb B, Fatmi SM, Martin B, Saint-Martin M. Incidental finding of Chilaiditi's sign in an elderly individual with sarcopenia. Intern Emerg Med 2016; 11:1021-2. [PMID: 26645215 DOI: 10.1007/s11739-015-1364-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2015] [Accepted: 11/24/2015] [Indexed: 11/26/2022]
Affiliation(s)
- Karen K Leung
- Division of Care of the Elderly, Glenrose Rehabilitation Hospital, Room 1263, 10230 111 Avenue Northwest, Edmonton, AB, T5G 0B7, Canada.
- Department of Family Medicine, University of Alberta, 205 College Plaza, 8215 112 Street Northwest, Edmonton, AB, T6G 2C8, Canada.
| | - Bryan Frobb
- Faculty of Medicine and Dentistry, 2J2.00 WC Mackenzie Health Sciences Centre, University of Alberta, 8440 112 Street Northwest, Edmonton, AB, T6G 2R7, Canada
| | - S Mim Fatmi
- Faculty of Medicine and Dentistry, 2J2.00 WC Mackenzie Health Sciences Centre, University of Alberta, 8440 112 Street Northwest, Edmonton, AB, T6G 2R7, Canada
| | - Bradley Martin
- Department of Family Medicine, University of Alberta, 205 College Plaza, 8215 112 Street Northwest, Edmonton, AB, T6G 2C8, Canada
| | - Marc Saint-Martin
- Division of Care of the Elderly, Glenrose Rehabilitation Hospital, Room 1263, 10230 111 Avenue Northwest, Edmonton, AB, T5G 0B7, Canada
- Department of Family Medicine, University of Alberta, 205 College Plaza, 8215 112 Street Northwest, Edmonton, AB, T6G 2C8, Canada
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Saito T, Chiba T, Ogasawara S, Inoue M, Wakamatsu T, Motoyama T, Kanogawa N, Suzuki E, Ooka Y, Tawada A, Matsubara H, Yokosuka O. Fatal Diaphragmatic Hernia following Radiofrequency Ablation for Hepatocellular Carcinoma: A Case Report and Literature Review. Case Rep Oncol 2015; 8:238-45. [PMID: 26120308 PMCID: PMC4478306 DOI: 10.1159/000431310] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
An 81-year-old man was admitted to our hospital because of right quadrant abdominal pain. On admission, his liver function was Child-Pugh grade C (10 points). Computed tomography (CT) revealed a diaphragmatic herniation of bowel loops into the right thoracic cavity, accompanied by pleural effusion. Although diaphragmatic hernia was successfully repaired by emergency surgery, he died of liver failure 23 days after the surgery. A retrospective reading of CT images revealed the presence of diaphragmatic injury after radiofrequency ablation (RFA) which had been conducted 33 months before the development of diaphragmatic hernia. Of importance, the lesion of the diaphragmatic injury was located on the estimated needle track of RFA for hepatocellular carcinomas in segment 5 and segment 5/8, but not adjacent to their ablation areas. Subsequently, diaphragmatic perforation had been observed 24 months before admission. This suggests that diaphragmatic hernia caused by RFA is not necessarily due to thermal damage of ablation and is possibly life-threatening, at least in some patients with an impaired liver function.
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Affiliation(s)
- Tomoko Saito
- Department of Gastroenterology and Nephrology, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Tetsuhiro Chiba
- Department of Gastroenterology and Nephrology, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Sadahisa Ogasawara
- Department of Gastroenterology and Nephrology, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Masanori Inoue
- Department of Gastroenterology and Nephrology, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Toru Wakamatsu
- Department of Gastroenterology and Nephrology, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Tenyu Motoyama
- Department of Gastroenterology and Nephrology, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Naoya Kanogawa
- Department of Gastroenterology and Nephrology, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Eiichiro Suzuki
- Department of Gastroenterology and Nephrology, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Yoshihiko Ooka
- Department of Gastroenterology and Nephrology, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Akinobu Tawada
- Department of Gastroenterology and Nephrology, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Hisahiro Matsubara
- Department of Frontier Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Osamu Yokosuka
- Department of Gastroenterology and Nephrology, Graduate School of Medicine, Chiba University, Chiba, Japan
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Chilaiditi's syndrome with interposed sigmoid colon mimicking traumatic pneumoperitoneum. CANADIAN JOURNAL OF GASTROENTEROLOGY = JOURNAL CANADIEN DE GASTROENTEROLOGIE 2013; 27:389. [PMID: 23862167 DOI: 10.1155/2013/864034] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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13
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Acute abdominal pain secondary to chilaiditi syndrome. Case Rep Surg 2013; 2013:756590. [PMID: 23936720 PMCID: PMC3713330 DOI: 10.1155/2013/756590] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2013] [Accepted: 06/16/2013] [Indexed: 12/19/2022] Open
Abstract
Chilaiditi syndrome is a rare condition occurring in 0.025% to 0.28% of the population. In these patients, the colon is displaced and caught between the liver and the right hemidiaphragm. Patients' symptoms can range from asymptomatic to acute intermittent bowel obstruction. Diagnosis is best achieved with CT imaging. Identification of Chilaiditi syndrome is clinically significant as it can lead to many significant complications such as volvulus, perforation, and bowel obstruction. If the patient is symptomatic, treatment is usually conservative. Surgery is rarely indicated with indications including ischemia and failure of resolution with conservative management.
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Al Skaini MS, Sardar A, Haroon H, Al Ghamdi SM, Homran A, Ezzedien Rabie M. Traumatic diaphragmatic hernia: delayed presentation with tension viscerothorax--lessons to learn. Ann R Coll Surg Engl 2013; 95:e27-9. [PMID: 23484976 PMCID: PMC4098607 DOI: 10.1308/003588413x13511609955337] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/21/2012] [Indexed: 11/22/2022] Open
Abstract
Diaphragmatic rupture is a serious complication of thoracoabdominal trauma. The condition may be missed initially. We describe the clinical course of a patient who sustained blunt abdominal trauma in a car accident. His diaphragmatic injury passed unnoticed, to present two years later with left tension viscerothorax, a rarely reported and hardly recognised entity. Nasogastric tube insertion aborted the emergency situation and the hernia was repaired successfully in a semielective setting.
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Affiliation(s)
- MS Al Skaini
- Armed Forces Hospitals Southern Region,Saudi Arabia
| | - A Sardar
- Armed Forces Hospitals Southern Region,Saudi Arabia
| | - H Haroon
- Armed Forces Hospitals Southern Region,Saudi Arabia
| | - SM Al Ghamdi
- Armed Forces Hospitals Southern Region,Saudi Arabia
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Lenz M, Kindler M, Schilling M, Pollack T, Schwab W, Becker M. [Chilaiditi's syndrome complicated by subdiaphragmatic perforated appendicitis: unusual manifestation of a rare condition]. Chirurg 2012; 82:828, 830-33. [PMID: 21725673 DOI: 10.1007/s00104-011-2138-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
We report on a case of an 80-year-old female patient who presented to the emergency room of with right upper quadrant abdominal pain since the day before. During the initial diagnostic an abdominal x-ray study revealed an air-filled colonic section of the bowel under the right hemidiaphragm corresponding to Chilaiditi's sign. The clinical symptoms and laboratory results were mild at this time. After 12 h the patient developed right upper quadrant peritonitis due to a perforated, subdiaphragmatic appendicitis based on Chilaiditi's syndrome. During surgical treatment the cecum and parts of the ascending colon were found to be interposed between the liver and right hemidiaphragm. A right hemicolectomy was performed which led to complete recovery of the patient. In addition to presenting this interesting case this article highlights the regime of the diagnostics and therapy of a complication of the very rare condition of Chilaiditi's syndrome.
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Affiliation(s)
- M Lenz
- Klinik für Allgemein- und Viszeralchirurgie, Weisseritztal-Kliniken GmbH, Freital, Deutschland.
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Abstract
Os autores apresentam um caso de síndrome de Chilaiditi em uma mulher de 56 anos de idade. Mesmo tratando-se de condição benigna com rara indicação cirúrgica, reveste-se de grande importância pela implicação de urgência operatória que representa o diagnóstico equivocado de pneumoperitônio nesses pacientes. É realizada revisão da literatura, com ênfase na fisiopatologia, propedêutica e tratamento desta entidade.
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