Chilaiditi's syndrome associated with colonic volvulus and intestinal malrotation-A rare case

A Case Report of Chilaiditi's Syndrome With Sigmoid Volvulus

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.

Caecal volvulus associated with complex small bowel malrotation and congenital bands: A case report and literature review

Caecal volvulus is an uncommon condition and represents only 10% of all colonic volvulus. The mechanism is due to hypermobile cecum twisting around it is own mesentery. A 40-year-old female who was previously fit and well-attended hospital with 2 days history of intermittent abdominal pain, mild distention and constipation. X-rays showed twisted and dilated loops of bowel with right hepato-diaphragmatic bowel loops entrapment. A computed tomography scan was the only confirmatory test of caecal volvulus with intermittent bowel symptoms. Emergency laparotomy revealed complex intraoperative bowel loops malrotation with congenital bands and abnormal position of Duodeno-Jejenal flexure. Open right hemicolectomy was the operation of choice for this complex case. Caecal volvulus must be considered as one of the important differential diagnosis of acute abdomen during initial assessment of patients with intermittent bowel symptoms in emergency department in order to avoid any therapeutic delay.

Intermittent abdominal pain accompanied by defecation difficulties caused by Chilaiditi syndrome: A case report

We report a case of intermittent lower abdominal pain and distension accompanied by defecation difficulties for 3 years due to Chilaiditi syndrome in a 59-year-old male. Before admission to our hospital, the patient had undergone gastroscopy, which showed gastritis and duodenitis, and colonoscopy, which showed cecum deformation and cicatricial changes of the mucous membrane in the colon hepatic flexure. A computed tomography (CT) scan of the abdomen at our hospital confirmed right hepatic atrophy and interposition of the colon. Moreover, CT simulation endoscopy identified cystic dilatation in the colon hepatic flexure with the widest diameter of 8.2 cm. The patient was diagnosed with Chilaiditi syndrome. As the patient was unable to endure his defecation difficulties, he underwent a laparoscope-assisted right hemicolectomy. The patient had a good recovery. During the follow-up period of 9 mo, the patient remained symptom-free.

Total midgut volvulus in adults with intestinal malrotation. Report of eleven patients

OBJECTIVE

Total small-intestinal volvulus with malrotation (TSIVM) classically presents in the neonatal period; it occurs much less frequently in the adult and is often misdiagnosed. Prognosis is directly related to the degree and duration of intestinal ischemia. Our goal is to describe our experience with TSIVM in the adult, to identify any specific findings and to discuss its management.

METHOD

Eleven patients who had undergone surgery for TSIVM at three centers between 1992 and 2012 were included. Surgery was performed as an emergency for five patients and surgery was elective for six.

RESULTS

Mean follow-up was 63 months (range: 12-270). Six patients had had previous abdominal surgery. In nine cases, the diagnosis of TSIVM was made preoperatively, mainly by CT scan in eight cases. Seven patients had associated congenital failure of retroperitoneal fixation of the right colon and all of these underwent a Ladd procedure. The mortality rate was zero. Of the five patients who underwent emergency surgery, three required intestinal resections, one of whom developed a short bowel syndrome. The six patients who underwent surgery electively had no surgical complications.

CONCLUSION

TSIVM is a very unusual finding in adult patients. The diagnosis can be made by CT scan with IV and oral contrast, but it often comes to light only at the time of surgery, even though the patients have often had recurrent episodes of abdominal symptomatology that dated back to childhood. The Ladd procedure, consisting of division of Ladd's bands, widening of the mesentery, and incidental appendectomy, remains the standard surgical repair. Digestive surgeons who care for adults should be familiar with this procedure, and it should be performed, as often as possible, with the assistance of a pediatric surgeon.

Chilaiditi Sign on 99mTc-Mebrofenin Hepatobiliary Scan Mimicking Bile Leak in Acute Cholecystitis

Chilaiditi sign is the incidental radiologic finding of intestinal interposition between the liver and diaphragm, whereas Chilaiditi syndrome describes the presence of accompanying clinical symptoms including abdominal pain, constipation, vomiting, and respiratory distress. We describe a case of radiotracer accumulation over the liver dome on Tc-mebrofenin hepatobiliary scan performed on a 72-year-old man with acute cholecystitis mimicking a bile leak. However, chest radiograph and CT revealed intestinal hepatodiaphragmatic interposition. This case illustrates the importance of being familiar with the scintigraphic appearance of the Chilaiditi sign and correlating abnormal nuclear medicine scan findings with other available radiologic modalities.

Anterior hepatic grooves accompanied by Chilaiditi sign: a retrospective radiological analysis of a neglected anatomical fact

PURPOSE

To evaluate anterior hepatic grooves (AHGs) associated with hepato-diaphragmatic mesocolic indentations (Chilaiditi sign) and to delineate the incidence and potential clinical significance of this association.

METHODS

Between November 2011 and June 2014, abdominal computed tomography examinations of 2,314 patients with varied indications were retrospectively reviewed. Patients were surveyed consecutively for the Chilaiditi sign and syndrome, and cases with grooves at the antero-inferior hepatic surface enclosing the adjacent mesocolic indents were determined. The incidence of AHGs and their predominance by gender and age were determined. The potential clinical significance of AHGs associated with Chilaiditi syndrome and their possible effect on liver volume were assessed.

RESULTS

The incidences of AHGs were similar between genders (p = .461 and p = .646) and age (p = .113 and .621, respectively) among total cohort and patients with Chilaiditi sign, respectively. There was no significant correlation between AHGs and Chilaiditi syndrome (p = .506); no efficacies of AHGs to liver volume were assessed (p = .413).

CONCLUSIONS

The AHGs are rare adaptive changes in shape of the liver without a significant effect on liver volume. This overlooked phenomenon is likely derived from the Chilaiditi sign, but has no significant correlation with Chilaiditi syndrome. Future studies with extended series are encouraged to reveal the possible significance of this phenomenon based on concerned surgical interventions.