1
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Saha B, Verma A, Coelho-Prabhu N, Kelm ZS, Cabrera D. Chilaiditi Syndrome Masquerading as Acute Cholecystitis. ACG Case Rep J 2024; 11:e01448. [PMID: 39035204 PMCID: PMC11259379 DOI: 10.14309/crj.0000000000001448] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2024] [Accepted: 06/24/2024] [Indexed: 07/23/2024] Open
Abstract
Chilaiditi sign is an incidental radiological finding where the intestine is interposed between the diaphragm and liver. Chilaiditi syndrome (CS), characterized by gastrointestinal symptoms and Chilaiditi sign on imaging, is of important clinical significance despite its rarity given associated complications including intestinal obstruction, bowel ischemia, and perforation. While most cases involve the large intestine, we report a rare case of CS with ileal involvement complicated by small bowel obstruction, managed conservatively. Failure to recognize Chilaiditi sign or CS may prompt unnecessary surgical interventions, emphasizing the need for physician awareness to ensure accurate timely diagnosis and appropriate management.
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Affiliation(s)
- Bibek Saha
- Department of Internal Medicine, Mayo Clinic, Rochester, MN
| | - Anjul Verma
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN
| | | | | | - Daniel Cabrera
- Department of Emergency Medicine, Mayo Clinic, Rochester, MN
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2
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Asanad S, Tewoldemedhin B, Singh S, Sood A, Michael MB. Thoracic Gut Entrapment Presenting As Intractable Hypoxia: A Case Report of Chilaiditi Syndrome. Cureus 2022; 14:e25963. [PMID: 35855261 PMCID: PMC9285638 DOI: 10.7759/cureus.25963] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/15/2022] [Indexed: 11/05/2022] Open
Abstract
We present a rare case of a patient who had intractable hypoxia and was found to have Chilaiditi syndrome. The hypoxia and respiratory symptoms resolved after bowel decompression and relief of the mass effect of the entrapped gut in the thorax. Chilaiditi sign is the interposition of the colon between the liver and diaphragm. Colonic interposition is a common asymptomatic radiological finding, in Chilaiditi syndrome, patients experience symptoms such as abdominal pain, constipation, respiratory distress, and chest pain.
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3
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Hartrich M, Eilbert W, Eisenberg A. Man with chest discomfort. J Am Coll Emerg Physicians Open 2022; 3:e12717. [PMID: 35462961 PMCID: PMC9016167 DOI: 10.1002/emp2.12717] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Accepted: 03/18/2022] [Indexed: 11/23/2022] Open
Affiliation(s)
- Molly Hartrich
- Department of Emergency Medicine University of Illinois at Chicago Hospital and Health Sciences System Chicago Illinois USA
| | - Wesley Eilbert
- Department of Emergency Medicine University of Illinois at Chicago Hospital and Health Sciences System Chicago Illinois USA
| | - Amy Eisenberg
- Combined Emergency Medicine/Internal Medicine Residency University of Illinois at Chicago Hospital and Health Sciences System Chicago Illinois USA
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4
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Basile EJ, Ahmed A, Rahman E, Rafa O, Frankini EL, Modica A. Chilaiditi Syndrome Presenting as Partial Colonic Obstruction. Cureus 2022; 14:e22975. [PMID: 35415042 PMCID: PMC8994044 DOI: 10.7759/cureus.22975] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/08/2022] [Indexed: 11/05/2022] Open
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5
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Gosavi R, Narasimhan V, Teoh W, Croagh D, Nguyen TC. Laparoscopic management of Chilaiditi syndrome. ANZ J Surg 2022; 92:2346-2347. [PMID: 35023273 DOI: 10.1111/ans.17469] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Accepted: 12/30/2021] [Indexed: 11/26/2022]
Affiliation(s)
- Rathin Gosavi
- Colorectal Unit, Dandenong Hospital, Monash Health, Melbourne, Victoria, Australia
| | - Vignesh Narasimhan
- Colorectal Unit, Dandenong Hospital, Monash Health, Melbourne, Victoria, Australia
| | - William Teoh
- Colorectal Unit, Dandenong Hospital, Monash Health, Melbourne, Victoria, Australia
| | - Daniel Croagh
- Colorectal Unit, Dandenong Hospital, Monash Health, Melbourne, Victoria, Australia
| | - Thang C Nguyen
- Colorectal Unit, Dandenong Hospital, Monash Health, Melbourne, Victoria, Australia
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6
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Caicedo L, Wasuwanich P, Rivera A, Lopez MS, Karnsakul W. Chilaiditi syndrome in pediatric patients - Symptomatic hepatodiaphragmatic interposition of colon: A case report and review of literature. World J Clin Pediatr 2021; 10:40-47. [PMID: 33972924 PMCID: PMC8085720 DOI: 10.5409/wjcp.v10.i3.40] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Revised: 02/04/2021] [Accepted: 03/10/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Chilaiditi syndrome is a rare disorder characterized by the hepatodiaphragmatic interposition of the intestine.
CASE SUMMARY Here we report a case of a 12-year-old male who was admitted to the pediatric intensive care unit secondary to abdominal pain and severe respiratory distress. He was treated conservatively but the symptoms persisted requiring a surgical approach. While there have been several cases of Chilaiditi syndrome reported in adults, there is a scarcity of cases reported in the pediatric population. Our review of the literature found only 30 pediatric cases, including our reported case, with Chilaiditi syndrome, 19 (63%) of which were male. The median age of diagnosis was 4.5 years old with an interquartile range of 2.0-10.0 years. In our review, we found that the most common predisposing factors in children are aerophagia (12/30 cases) and constipation (13/30 cases). Ninety percent of the cases presented with complete intestinal interposition, in 100% of which, the colon was involved. Three of the 30 cases were associated with volvulus.
CONCLUSION In the pediatric population, conservative (21/30 cases) and surgical (8/30 cases) treatment approaches have produced satisfactory outcomes for all the patients, regardless of approach.
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Affiliation(s)
- Luis Caicedo
- Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Nicklaus Children’s Hospital, Miami, FL 33155, United States
| | - Paul Wasuwanich
- Department of Medicine, University of Florida College of Medicine, Gainesville, FL 32610, United States
| | - Andrés Rivera
- Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York, NY 10092, United States
| | - Maria S Lopez
- Department of Pediatrics, Nicklaus Children’s Hospital, Miami, FL 33155, United States
| | - Wikrom Karnsakul
- Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD 21287, United States
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7
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Xu Y, Wang Q, Meng G, Li D, Ma Z, Gao P, Zhang J, Zhang Q, Su Z. A rare cause of sudden chest pain and dyspnea: A CARE-compliant case report of Chilaiditi syndrome. Medicine (Baltimore) 2020; 99:e20220. [PMID: 32443352 PMCID: PMC7253721 DOI: 10.1097/md.0000000000020220] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
RATIONALE Chilaiditi syndrome is a rare disorder characterized by a broad spectrum of (gastro-intestinal) symptoms caused by interposition of a segment of bowel between the liver and the diaphragm. Most cases present with abdominal symptoms and the morbidity tend to increase with age. PATIENT CONCERNS Here we present a rare case of Chilaiditi syndrome. An elderly postmenopausal woman developed unresolved postoperative respiratory symptoms and chest pain. Chest auscultation revealed considerable attenuation of respiratory sounds. She showed postoperative increase in D-dimer level and sudden onset of dyspnea. DIAGNOSES Considering the presence of atelectasis in the middle and lower lobes of the right lung, bedside fiberoptic bronchoscopy was performed immediately to rule out bronchial phlegm embolism. However, no phlegm embolism was found in the left lung, and a small amount of yellow-white mucus was seen in the upper lobe of the right lung. Due to external pressure, the lumen of the middle and lower lobes of the right lung was obviously narrowed. INTERVENTIONS The patient was placed in a semi-sitting position and a tube was passed through the anus to decompress the intestinal cavity; in addition, she received potassium supplementation. OUTCOMES The patient's symptoms improved markedly. Chest and semi-supine abdominal plain radiographs showed enhanced lung markings, shadows in the left lower lung lobes, elevation of the right diaphragm, and small amount of pneumoperitoneum. The patient recovered after 5 days of continuous treatment and was discharged. LESSONS Emergency computed tomographic pulmonary angiography may facilitate the diagnosis of Chilaiditi syndrome, especially in the postoperative setting. Occurrence of Chilaiditi syndrome in this patient was likely associated with surgical factors. Appropriate investigations and clear identification of etiology are essential for successful treatment.
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Affiliation(s)
- Yanling Xu
- Department of Respiratory Medicine
- Department of Geriatrics and General Medicine
| | - Qi Wang
- Department of Respiratory Medicine
| | | | - Dapeng Li
- Departments of Respiratory Medicine, Affiliated Hospital of Jilin Medical University, Jilin, Jilin 132000
| | - Zhiming Ma
- Department of Gastrointestinal Nutrition and Hernia Surgery
| | - Peng Gao
- Department of Respiratory Medicine
| | | | - Qun Zhang
- Department of Respiratory Medicine
- Department of Critical Care Medicine, The Second Affiliated Hospital of Jilin University, Changchun, Jilin 130041, China
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8
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Luo XG, Wang J, Wang WL, Yu CZ. Intermittent abdominal pain accompanied by defecation difficulties caused by Chilaiditi syndrome: A case report. World J Clin Cases 2018; 6:1042-1046. [PMID: 30568961 PMCID: PMC6288512 DOI: 10.12998/wjcc.v6.i15.1042] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2018] [Revised: 10/18/2018] [Accepted: 10/22/2018] [Indexed: 02/05/2023] Open
Abstract
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.
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Affiliation(s)
- Xia-Gang Luo
- Department of General Surgery, the Second Affiliated Hospital of Nanjing Medical University, Nanjing 210011, Jiangsu Province, China
| | - Jing Wang
- Department of General Surgery, the Second Affiliated Hospital of Nanjing Medical University, Nanjing 210011, Jiangsu Province, China
| | - Wu-Lin Wang
- Department of General Surgery, the Second Affiliated Hospital of Nanjing Medical University, Nanjing 210011, Jiangsu Province, China
| | - Chun-Zhao Yu
- Department of General Surgery, the Second Affiliated Hospital of Nanjing Medical University, Nanjing 210011, Jiangsu Province, China
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9
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Dsouza S, Mhaske Y, Kulkarni A, Baviskar A. Chilaiditi syndrome—a clinical conundrum! SOUTHERN AFRICAN JOURNAL OF ANAESTHESIA AND ANALGESIA 2018. [DOI: 10.1080/22201181.2018.1523978] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- Supriya Dsouza
- Department of Critical Care, Global Hospital, Mumbai, India
| | - Yuvraj Mhaske
- Department of Critical Care, Global Hospital, Mumbai, India
| | - Adarsh Kulkarni
- Department of Anaesthesiology, Seth GS Medical College and KEM Hospital, Mumbai, India
| | - Ajit Baviskar
- Department of Critical Care, Global Hospital, Mumbai, India
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10
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Sunkara T, Rawla P, Yarlagadda KS, Baltazar GA, Gaduputi V. Chilaiditi Syndrome Complicated by Cecal Perforation in the Setting of Scleroderma. J Investig Med High Impact Case Rep 2018; 6:2324709618803387. [PMID: 30283808 PMCID: PMC6166301 DOI: 10.1177/2324709618803387] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2018] [Revised: 08/30/2018] [Accepted: 09/04/2018] [Indexed: 12/19/2022] Open
Abstract
Chilaiditi syndrome is a very rare disorder characterized by abdominal pain due
to the entrapment of the colon between the liver and the diaphragm. However, it
is rare to have bowel perforation as a complication of this syndrome with only 2
cases reported to date. In this article, we present the case of a 56-year-old
woman with medical history of scleroderma who presents with abdominal pain and
was found to have colonic perforation from Chilaiditi syndrome. She was also
incidentally found to have cecal adenocarcinoma. Sometimes abdominal pain in
patients with Chilaiditi syndrome may be more than benign and calls for
increased attention from clinicians regarding this.
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Affiliation(s)
- Tagore Sunkara
- The Brooklyn Hospital Center, Clinical
Affiliate of the Mount Sinai Hospital, New York, NY, USA
- Tagore Sunkara, MD, Department of Internal
Medicine, Division of Gastroenterology, the Brooklyn Hospital Center, Clinical
Affiliate of the Mount Sinai Hospital, 121 Dekalb Avenue, Brooklyn, NY 11201,
USA.
| | - Prashanth Rawla
- Memorial Hospital of Martinsville and
Henry County, Martinsville, VA, USA
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11
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Harpain F, Gasché C, Prager G, Silberhumer GR. A siphon-like retrogastric transverse colon: A case report. Int J Surg Case Rep 2018; 44:110-113. [PMID: 29499513 PMCID: PMC5910513 DOI: 10.1016/j.ijscr.2018.01.009] [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: 09/20/2017] [Revised: 12/26/2017] [Accepted: 01/18/2018] [Indexed: 11/16/2022] Open
Abstract
INTRODUCTION Intestinal interposition is a term that describes rare anatomic variations where parts of the colon deviate from their normal intraabdominal position, attaching between two organs. Most patients with colonic interpositions are asymptomatic and diagnosed incidentally by computed tomography or ultrasound. Here we present a case of a symptomatic restrogastric colon, interposing kinked between stomach and pancreas. PRESENTATION OF CASE A 66-year old female patient presented with an eight-year history of intermittent spastic bowel movements, epigastralgia and nausea. Consecutively, the patient lost 12 kg. Physical examination was unremarkable and routine blood tests were within normal limits. Subsequently performed colonoscopy and cross-sectional imaging diagnosed a retrogastric colon. Finally, the patient underwent surgical treatment. The intraoperative findings were consistent with the computed tomography images and showed a kinked retrogastric protrusion of the transverse colon into the lesser sac, adhering to both, the posterior wall of the stomach, and the anterior surface of the pancreas. After adhesiolysis and mobilization, the transverse colon slipped back to the normal position within the abdominal cavity. The patient recovered well after surgery and was discharged on the sixth postoperative day. Six-month follow-up revealed cured bowel function, weight regain and no signs of recurrence. DISCUSSION & CONCLUSION These rare cases of intestinal interpositions are very often difficult to diagnose, as symptoms are misleading. In case of diagnosis adequate surgical treatment strategies should be considered.
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Affiliation(s)
- Felix Harpain
- Department of Surgery, Division of Transplantation, Medical University of Vienna, Waehringer Gürtel 18-20, 1090 Vienna, Austria
| | - Christoph Gasché
- Department of Internal Medicine III, Division of Gastroenterology and Hepatology, Medical University of Vienna, Waehringer Gürtel 18-20, 1090 Vienna, Austria
| | - Gerhard Prager
- Department of Surgery, Division of Visceral Surgery, Medical University of Vienna, Waehringer Gürtel 18-20, 1090 Vienna, Austria
| | - Gerd R Silberhumer
- Department of Surgery, Division of Transplantation, Medical University of Vienna, Waehringer Gürtel 18-20, 1090 Vienna, Austria.
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12
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Smereczyński A, Kołaczyk K. Is it possible to differentiate between pseudopneumoperitoneum and similar pathologies ultrasonographically? J Ultrason 2017; 17:30-35. [PMID: 28439426 PMCID: PMC5392551 DOI: 10.15557/jou.2017.0004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2015] [Revised: 08/26/2015] [Accepted: 08/30/2015] [Indexed: 01/07/2023] Open
Abstract
Aim The goal of the work was comparing gas ultrasound images below the right diaphragm in two groups: in people with intestinal interposition below the diaphragm and ones with pneumoperitoneum and extracting the traits differentiating these two conditions. Material and methods Retrospectively, the documentation of 22 patients with intestinal interposition below the diaphragm (group 1) was utilized. Clinical material was used for comparison, previously published, composed of 15 cases of pneumoperitoneum following laparotomy and of 14 cases following that symptom as a result of ulcer perforation – group 2 (in total n = 29). Moreover, the distance in millimeters of the gas surface reflecting ultrasounds from the parietal peritoneum was measured, the smoothness of the surface, parietal peritoneum enhancement at the place of gas adherence, gas continuity below the diaphragm with gas in the intestine located below the liver. Results Direct adherence of the gas surface to the diaphragm was observed in 100% of the cases of emphysema, but in no cases of intestinal interposition. Yet, in the group of patients with colonic interposition (n = 21) there was always a small gap (2–3 mm) and the gas surface among those patients in 100% of the cases was uneven. Conclusions In differentiation between pneumoperitoneum and liver-diaphragm interposition of the intestine one should take into account – apart from gas movement below the diaphragm at body position changing – the presence of protrusion and section enhancement of the diaphragmatic peritoneum as well as the distance of the gas from the diaphragm, the smoothness of its surface and the continuity with the intestine below the liver. Interpositions of small diaphragm-liver penetration may subside in erect position.
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Affiliation(s)
- Andrzej Smereczyński
- Genetics and Pathomorphology Center of the Pomeranian Medical University, Szczecin, Poland Self-Training Ultrasonography Circle, Szczecin, Poland
| | - Katarzyna Kołaczyk
- Genetics and Pathomorphology Center of the Pomeranian Medical University, Szczecin, Poland Self-Training Ultrasonography Circle, Szczecin, Poland
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13
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Takahashi K, Ito H, Katsube T, Tsuboi A, Hashimoto M, Ota E, Mita K, Asakawa H, Hayashi T, Fujino K. Treatment of Chilaiditi syndrome using laparoscopic surgery. Asian J Endosc Surg 2017; 10:63-65. [PMID: 27651120 DOI: 10.1111/ases.12319] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2016] [Revised: 06/23/2016] [Accepted: 07/10/2016] [Indexed: 12/20/2022]
Abstract
Chilaiditi syndrome is defined as the interposition of the bowel between the liver and right diaphragm. It is a rare disease and may be difficult to diagnose and manage. Treatment for asymptomatic patients with Chilaiditi is usually conservative and does not require surgical intervention, but surgery may be necessary if conservative treatment fails. This report describes a rare case of Chilaiditi syndrome causing small bowel obstruction and corrected using laparoscopic surgery.
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Affiliation(s)
| | - Hideto Ito
- Department of Surgery, New-Tokyo Hospital, Matsudo, Japan
| | - Toshio Katsube
- Department of Surgery, New-Tokyo Hospital, Matsudo, Japan
| | - Ayaka Tsuboi
- Department of Surgery, New-Tokyo Hospital, Matsudo, Japan
| | | | - Emi Ota
- Department of Surgery, New-Tokyo Hospital, Matsudo, Japan
| | - Kazuhito Mita
- Department of Surgery, New-Tokyo Hospital, Matsudo, Japan
| | - Hideki Asakawa
- Department of Surgery, New-Tokyo Hospital, Matsudo, Japan
| | | | - Keiichi Fujino
- Department of Surgery, New-Tokyo Hospital, Matsudo, Japan
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14
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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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15
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Chilaiditi Sign on 99mTc-Mebrofenin Hepatobiliary Scan Mimicking Bile Leak in Acute Cholecystitis. Clin Nucl Med 2016; 41:488-9. [PMID: 26859214 DOI: 10.1097/rlu.0000000000001155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
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.
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16
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Watanabe M, Ishibashi O, Watanabe M, Kondo T, Ohkohchi N. Complicated adult right-sided Bochdalek hernia with Chilaiditi's syndrome: a case report. Surg Case Rep 2015; 1:95. [PMID: 26943419 PMCID: PMC4595410 DOI: 10.1186/s40792-015-0100-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2015] [Accepted: 10/01/2015] [Indexed: 11/10/2022] Open
Abstract
An extremely rare adult case that underwent surgery for ileus caused by Bochdalek hernia associated with Chilaiditi’s syndrome is presented. A 65-year-old woman complaining of upper abdominal pain presented to our hospital. Abdominal plain radiography showed increased intestinal gas, and computed tomography (CT) showed the transverse colon located above the right lobe of the liver, representing Chilaiditi’s sign. She was diagnosed as having ileus and treated with decompression therapy by a nasoenteric tube. After hospitalization, the patient developed dyspnea, and CT showed intestinal herniation into the right thoracic cavity. She was diagnosed as having strangulated ileus caused by Bochdalek hernia. An emergent laparotomy was performed, and it showed a hole of 5 cm in diameter at the right hemi-diaphragm. The transverse colon was incarcerated through the hole, it was pulled back to the abdominal cavity, and a right hemicolectomy was performed because of necrotic changes. A small part of the liver was also herniated into the right thoracic cavity, and it was returned to the abdominal cavity. The defect in the diaphragm was closed by direct suture. Although the patient developed an abscess in the thoracic cavity postoperatively, she improved with antibiotic therapy and was discharged 2 months after the operation.
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Affiliation(s)
- Motonobu Watanabe
- Department of Surgery, Graduate School of Comprehensive Human Sciences, University of Tsukuba, 1-1-1 Tennoudai, Tsukuba, Ibaraki, 305-8558, Japan. .,Department of Surgery, Mito Kyodo General Hospital, 3-2-7 Miyamachi, Mito, Ibaraki, 310-0015, Japan. .,Department of Surgery, Moriya Daiichi General Hospital, 1-17 Matsumaedai, Moriya, Ibaraki, 302-0102, Japan.
| | - Osamu Ishibashi
- Department of Surgery, Mito Kyodo General Hospital, 3-2-7 Miyamachi, Mito, Ibaraki, 310-0015, Japan.
| | - Muneaki Watanabe
- Department of Surgery, Mito Kyodo General Hospital, 3-2-7 Miyamachi, Mito, Ibaraki, 310-0015, Japan.
| | - Tadashi Kondo
- Department of Surgery, Graduate School of Comprehensive Human Sciences, University of Tsukuba, 1-1-1 Tennoudai, Tsukuba, Ibaraki, 305-8558, Japan. .,Department of Surgery, Mito Kyodo General Hospital, 3-2-7 Miyamachi, Mito, Ibaraki, 310-0015, Japan.
| | - Nobuhiro Ohkohchi
- Department of Surgery, Graduate School of Comprehensive Human Sciences, University of Tsukuba, 1-1-1 Tennoudai, Tsukuba, Ibaraki, 305-8558, Japan.
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17
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Ho MP, Cheung WK, Tsai KC, Chou AH. Chilaiditi Syndrome Mimicking Subdiaphragmatic Free Air in an Elderly Adult. J Am Geriatr Soc 2014; 62:2019-21. [DOI: 10.1111/jgs.13052] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Min-Po Ho
- Department of Emergency Medicine; Far Eastern Memorial Hospital; New Taipei City Taiwan
| | - Wing-Keung Cheung
- Division of Medical Imaging; Department of Radiology; Far Eastern Memorial Hospital; New Taipei City Taiwan
| | - Kuang-Chau Tsai
- Department of Emergency Medicine; Far Eastern Memorial Hospital; New Taipei City Taiwan
| | - An-Hsun Chou
- Department of Anesthesiology; Chang Gung Memorial Hospital; College of Medicine; Chang Gung University; Taoyuan Taiwan
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Weng WH, Liu DAR, Feng CC, Que RS. Colonic interposition between the liver and left diaphragm - management of Chilaiditi syndrome: A case report and literature review. Oncol Lett 2014; 7:1657-1660. [PMID: 24765195 PMCID: PMC3997735 DOI: 10.3892/ol.2014.1903] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2013] [Accepted: 01/30/2014] [Indexed: 12/02/2022] Open
Abstract
Chilaiditi syndrome refers to a medical condition that is indicated by the presence of Chilaiditi sign, the radiological observation of a colonic interposition between the liver and the diaphragm, and is associated with other clinical symptoms. Chilaiditi syndrome is a rare entity and therefore, is often misdiagnosed in clinical practice, however, it may be accompanied by a series of severe complications, such as bowel obstruction and perforation. The current study describes a 47-year-old male who presented with repeated abdominal pain and acute intestinal obstruction. The patient was diagnosed with Chilaiditi syndrome via radiological observation and was cured by conservative treatment. The clinical data of seven additional patients with Chilaiditi syndrome, which was reported in the Chinese literature between January 1990 and January 2013, were also collected. The pathogenesis, clinical manifestation, diagnosis and treatment of this syndrome have been reviewed and analyzed. The current study may be useful to familiarize clinical practitioners with Chilaiditi syndrome, in order to avoid a misdiagnosis during clinical treatment.
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Affiliation(s)
- Wei-Hong Weng
- Department of General Surgery, The Second Affiliated Hospital, Zhejiang University, Hangzhou, Zhejiang 310009, P.R. China
| | - DA-Ren Liu
- Department of General Surgery, The Second Affiliated Hospital, Zhejiang University, Hangzhou, Zhejiang 310009, P.R. China
| | - Cheng-Cheng Feng
- Department of Surgery, Cixi Red Cross Hospital, Cixi, Zhejiang 315300, P.R. China
| | - Ri-Sheng Que
- Department of General Surgery, The Second Affiliated Hospital, Zhejiang University, Hangzhou, Zhejiang 310009, P.R. China
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Zhou H, Hu Z. Man With Air Below the Right Diaphragm. Ann Emerg Med 2014; 63:13, 47. [DOI: 10.1016/j.annemergmed.2013.06.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2013] [Revised: 05/31/2013] [Accepted: 06/03/2013] [Indexed: 11/12/2022]
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A coincidental association: Chilaiditi anomaly in an elderly patient with membranoproliferative glomerulonephritis. Eur Geriatr Med 2013. [DOI: 10.1016/j.eurger.2013.01.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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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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Affiliation(s)
- Huan-Lun Hsu
- Department of Internal Medicine, China Medical University Hospital, Taipei Branch, Taipei, Taiwan
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Subphrenic Displacement of the Colon: From Sign to Syndrome. South Med J 2009; 102:782-3. [DOI: 10.1097/smj.0b013e3181ad5d91] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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