Treatment of Chilaiditi syndrome using laparoscopic surgery

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.

Chilaiditi syndrome - a rare case of pneumoperitoneum in the emergency department: a case report

Background

Pneumoperitoneum poses an important diagnostic sign determining the urgency of management of patients in an emergency department. Chilaiditi sign is a rare radiologic finding of large intestines transposition between the diaphragm and the liver. If the patient becomes symptomatic, then the condition is called Chilaiditi syndrome.

Case presentation

We present a rare case of a 49-year-old Egyptian man who presented to our emergency department complaining of cough and vague abdominal discomfort who was found to have Chilaiditi syndrome diagnosed radiologically by computed tomography scan. He was conservatively managed rather than undergoing invasive non-warranted diagnostic and therapeutic testing that may have resulted in increased morbidity.

Conclusions

A review of the current literature on Chilaiditi syndrome is provided with a focus on increasing the familiarity of health care professionals with the conditions and stressing the importance of a physical examination in evaluating patients with what appears to be air under the diaphragm.

A case of liver cirrhosis and Chilaiditi syndrome with atypical pneumonitis

Respiratory distress is very uncommon as a presenting symptom of Chilaiditi syndrome. Furthermore, pneumonia is not documented with the syndrome, compromising further to the distress. We describe a middle-aged man, chronic alcoholic, recently diagnosed with liver cirrhosis, presented with a 1-year history of slowly progressive breathlessness. Recently, he developed mild-to-moderate hemoptysis and cough with aggravation of breathlessness. He did not have fever, chest pain, or orthopnea. He was cyanosed, requiring high-dose oxygen therapy. Later on, he stabilized with noninvasive ventilation. Chest imagings showed incidental Chilaiditi sign, liver cirrhosis, and atypical pneumonitis. With empirical antibiotics and high-dose steroid, he recovered completely but with baseline breathlessness. Here, we outline Chilaiditi syndrome as a rare association or manifestation of liver cirrhosis, and it can present with a respiratory compromise by both obstructive lung disease and atypical interstitial pneumonia. Early identification, vaccinations against common organisms, and possible early surgery may prevent morbidity and mortality of this type of patients.

Chilaiditi's Sign Associated with Acute Colonic Pseudo-obstruction: A Radiological Diagnosis

Chilaiditi’s sign is a rare radiological anomaly of hepato-diaphragmatic interposition of the bowel. We report a case of Chilaiditi’s sign associated with acute colonic pseudo-obstruction.

A 90-year-old male was admitted for hypertensive emergency. His physical examination showed a distended abdomen, decreased bowel sounds, and right upper quadrant tenderness. A chest radiograph demonstrated marked elevation of the right diaphragm and interposition of the hepatic flexure of the colon between the diaphragm and the liver, along with marked gaseous distension up to 9 cm in the ascending colon without any small bowel distension. The patient was managed conservatively with bowel rest, stool softeners, enemas, and intravenous (IV) hydration. The patient improved clinically with resolution of colonic distension.

Chilaiditi's sign and Chilaiditi syndrome are rare entities and therefore are often misdiagnosed and mismanaged. Awareness of the radiological sign, the syndrome itself, and the association with acute colonic pseudo-obstruction is important for all care providers so that they can opt for more conservative management strategies instead of unnecessary interventions including surgeries.

Surgical management of Chilaiditi syndrome with da Vinci® robotic system

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Elderly woman suffers from abdominal pain from Chilaiditi’s syndrome.

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Robotic-assisted surgery affords great visualization and instrument dexterity.

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She undergoes first known robotic-assisted colopexy for this condition.

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Post-operative course is uneventful and her recovery is swift.

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Robotic-assisted surgery is a useful technique for intra-corporeal suturing.

Introduction

Chilaiditi’s syndrome is a combination of radiographic finding of hepato-diaphragmatic interposition of intestine with gastrointestinal symptoms which sometimes requires operative intervention. This is, to our knowledge, the first report of robotic-assisted technique for surgical management of this rare condition.

Presentation of case

We report a case of 85-year-old woman with persistent pain and diarrhea from Chilaiditi’s syndrome who underwent robotic-assisted colopexy with good outcome.

Discussion

Robotic-assisted surgery offers great visualization and high degree of instrument maneuverability, thus shortening operative time and provides patient with other benefits of minimally-invasive surgery such as minimal pain and excellent cosmesis.

Conclusion

Robotic-assisted surgical technique allowed quick recovery and return to baseline function for a frustrated elderly patient.