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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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Kao CT, Dunkley M, Hodgson R. Surgical management of large bowel obstruction and significant hepatic displacement caused by Chilaiditi syndrome. BMJ Case Rep 2023; 16:e255047. [PMID: 38035675 PMCID: PMC10689414 DOI: 10.1136/bcr-2023-255047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2023] Open
Abstract
Chilaiditi's sign is the presence of pseudopneumoperitoneum caused by colonic distension and interposition with the liver on radiographic films. Most patients with Chilaiditi's sign are asymptomatic. Chilaiditi's syndrome is defined as the development of abdominal pain or symptoms of bowel obstruction along with the presence of Chilaiditi's sign. It is a rare entity and it poses significant diagnostic challenges due to its similar radiographic appearance to pneumoperitoneum. Most patients with Chilaiditi syndrome can be managed conservatively. However, surgery is indicated for those who do not respond to conservative management or for suspicion of severe complications such as bowel ischaemia or perforation. In this case report, we described the surgical management of a patient who presented with bowel obstruction and significant hepatic displacement from Chilaiditi syndrome.
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Affiliation(s)
- Chien-Tse Kao
- Surgery, Northern Hospital Health Sciences Library, Epping, Victoria, Australia
| | - Margaret Dunkley
- General Surgery, Mildura Base Public Hospital, Mildura, Victoria, Australia
| | - Russell Hodgson
- Surgery, Northern Hospital Health Sciences Library, Epping, Victoria, Australia
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3
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Silva FS, Moutinho J, Vasconcelos T, Simões IG. Chilaiditi Syndrome: A Rare Case and Clinical Insights for Diagnosis and Management. Cureus 2023; 15:e48932. [PMID: 38106749 PMCID: PMC10725527 DOI: 10.7759/cureus.48932] [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: 11/16/2023] [Indexed: 12/19/2023] Open
Abstract
Chilaiditi syndrome is a rare medical condition characterized by the interposition of a hollow organ, usually the colon, between the liver and diaphragm, leading to abdominal pain, discomfort, bloating, constipation, or nausea; in more severe instances, respiratory symptoms may manifest due to pressure on the diaphragm. The exact cause remains unclear but is thought to present along with various factors such as anatomical anomalies (hepato-diaphragmatic interposition and intestinal malrotation) and chronic conditions (cirrhosis or chronic obstructive pulmonary disease). This case report presents a 78-year-old male with rapid deterioration, confusion, and mild abdominal discomfort. Clinical and radiological examinations confirmed Chilaiditi syndrome, highlighting the challenges in diagnosis. Management strategies range from conservative approaches to surgical interventions, emphasizing the need for increased clinical awareness among physicians to ensure accurate and timely interventions. This case report underscores the importance of recognizing this rare condition.
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Affiliation(s)
- Frederico S Silva
- Internal Medicine, Centro Hospitalar Universitário do Algarve - Unidade de Portimão, Portimão, PRT
| | - Joana Moutinho
- Internal Medicine, Centro Hospitalar Universitário do Algarve - Unidade de Portimão, Portimão, PRT
| | - Tiago Vasconcelos
- Internal Medicine, Centro Hospitalar Universitário do Algarve - Unidade de Portimão, Portimão, PRT
| | - Inês G Simões
- Internal Medicine, Centro Hospitalar Universitário do Algarve - Unidade de Portimão, Portimão, PRT
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4
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Adu Y, Nesiama EA, Siddiqui A, Prakash S, Obokhare I. Chilaiditi Syndrome: A Case Report, Literature Review, and Proposition of a Novel Management Staging System. Cureus 2023; 15:e46688. [PMID: 37942369 PMCID: PMC10629610 DOI: 10.7759/cureus.46688] [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: 10/07/2023] [Indexed: 11/10/2023] Open
Abstract
Chilaiditi's sign refers to colonic interposition between the liver and the diaphragm in the right subphrenic space secondary to the relaxation of the suspensory ligaments of the right colic flexure. The diagnosis of Chilaiditi's sign is based on radiological findings with the following three criteria: 1) The right hemidiaphragm must be adequately elevated above the liver by the intestine, 2) the bowel must be distended by air to illustrate pseudo-pneumoperitoneum, and 3) the superior margin of the liver must be depressed below the level of the left hemidiaphragm. In this report, we present the case of a 49-year-old female presenting with signs and symptoms suggestive of Chilaiditi syndrome managed with laparoscopic surgery. We also present a literature review with a summary of previous studies and propose a novel management staging system for this syndrome.
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Affiliation(s)
- Yaw Adu
- School of Medicine, Texas Tech University Health Sciences Center, Lubbock, USA
| | - Esere A Nesiama
- School of Medicine, Texas Tech University Health Sciences Center, Lubbock, USA
| | - Arham Siddiqui
- Department of Internal Medicine, University of Texas Health Science Center, San Antonio, USA
| | - Sameer Prakash
- Department of Internal Medicine, University of Iowa Hospitals and Clinics, Iowa City, USA
| | - Izi Obokhare
- Department of General Surgery, Texas Tech University Health Sciences Center, Amarillo, USA
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5
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Richardson B, Hickham L, Harper S, Soliman B. Delayed Right Diaphragmatic Hernia With Chilaiditi Syndrome: A Case Report. Cureus 2023; 15:e41420. [PMID: 37546117 PMCID: PMC10403295 DOI: 10.7759/cureus.41420] [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: 07/05/2023] [Indexed: 08/08/2023] Open
Abstract
Diaphragmatic hernias can be congenital or acquired and manifest as a defect thus allowing abdominal contents to protrude into the thorax through the defect. Common presentations and symptoms can include shortness of breath, nausea, vomiting, and abdominal pain. Rarely colon or small bowel is interposed between the liver and the diaphragm, Chilaiditi sign. When the Chilaiditi sign is accompanied by symptoms it is termed Chilaiditi syndrome. We present a case of a 41-year-old male who was involved in a motor vehicle accident 12 years prior and presented with a right diaphragmatic hernia and Chilaiditi syndrome. The patient presented with a 21-hour history of abdominal pain, nausea, and vomiting. A computed tomography scan of the chest and abdomen revealed the presence of Chilaiditi sign, wherein the large bowel was positioned above the liver, having herniated through a diaphragmatic defect. The patient subsequently underwent an exploratory laparotomy which confirmed an 8 x 4 cm right diaphragmatic defect. Primary repair was completed with intraperitoneal mesh. Diaphragmatic hernias pose diagnostic challenges due to their variable symptomatology and possible delayed onset. Consequently, the importance of including diaphragmatic hernia as part of the differential diagnoses for patients experiencing abdominal pain and/or difficulty breathing is highlighted by this case, especially for individuals with a distant record of trauma.
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Affiliation(s)
- Bayley Richardson
- Surgery, Texas Tech University Health Sciences Center School of Medicine, Amarillo, USA
| | - Leigh Hickham
- Dermatology, Louisiana State University Health Sciences Center, New Orleans, USA
| | - Shane Harper
- Surgery, Texas Tech University Health Sciences Center, Amarillo, USA
| | - Basem Soliman
- Surgery, Texas Tech University Health Sciences Center, Amarillo, USA
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6
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Tominaga Y, Hirayama I, Nonaka M, Yano T, Kurihara K, Ishii M. Coronavirus disease 2019 with Chilaiditi sign. Clin Case Rep 2023; 11:e7243. [PMID: 37155423 PMCID: PMC10122685 DOI: 10.1002/ccr3.7243] [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: 03/07/2023] [Revised: 03/25/2023] [Accepted: 04/07/2023] [Indexed: 05/10/2023] Open
Abstract
In patients with the Chilaiditi sign, pulmonary lower lobes collapse occurs because of interposition of the bowel between diaphragm and liver. When such patients suffer from COVID-19 pneumonia, clinicians should carefully monitor respiratory status.
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Affiliation(s)
- Yoshiteru Tominaga
- Department of Emergency MedicineNational Hospital Organization Saitama HospitalSaitamaJapan
| | - Ichiro Hirayama
- Department of Emergency MedicineNational Hospital Organization Saitama HospitalSaitamaJapan
| | - Minaho Nonaka
- Department of Emergency MedicineNational Hospital Organization Saitama HospitalSaitamaJapan
| | - Tetsuhiro Yano
- Department of Emergency MedicineNational Hospital Organization Saitama HospitalSaitamaJapan
| | - Kazuto Kurihara
- Department of Emergency MedicineNational Hospital Organization Saitama HospitalSaitamaJapan
| | - Mitsuru Ishii
- Department of Emergency MedicineNational Hospital Organization Saitama HospitalSaitamaJapan
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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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8
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Kaya H, Karatay E, Tuney D. The volumetric measurement of developing liver atrophy in patients with Chilaiditi's sign. SURGICAL AND RADIOLOGIC ANATOMY : SRA 2022; 44:1239-1246. [PMID: 36053336 DOI: 10.1007/s00276-022-03013-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Accepted: 08/24/2022] [Indexed: 11/26/2022]
Abstract
PURPOSE The Chilaiditi's sign is a hepatodiaphragmatic interposition of the colon and is a rare diagnosed condition. This condition may cause a problem in liver transplantation applications which are progressively increasing in number. Although not reported in the literature, we observed that liver atrophy developed in the intestinal interposition region in patients with Chilaiditi's sign in computed tomography (CT) images. This study aimed to determine the amount of liver atrophy caused by the interposed colon, the factors that change the rate of atrophy, and the effects of this situation on the liver parenchyma. MATERIALS AND METHODS A total of 30,000 patients who presented to radiology department with any reason between March 2012 and March 2013 and who underwent thoracoabdominal or abdominal CT imaging were retrospectively analyzed. The volumes of the liver right lobe and lateral/medial segments of the left lobe were estimated in cm3 using Volume Viewer application in 75 cases (20 females, 55 males) in which Chilaiditi's sign was observed in CT images. RESULTS 17-27% of the lobes affected from the colon interposition were seen to develop atrophy. The ratio of right lobe volume to total liver volume was found to be higher in patients with left lobe atrophy (74%) than right lobe atrophy (55%) (p < 0.001). Similarly, the rate of the volume of the left lobe to the total liver volume was found to be higher in cases with right lobe atrophy (45%) compared to left lobe atrophy (26%) (p < 0.001). CONCLUSION Hepatodiaphragmatic interposition of the colon can cause liver atrophy. This condition should especially be considered in the liver transplantation applications. Compensatory hypertrophy may develop in the unaffected liver lobe and CT is very useful for diagnostic imaging.
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Affiliation(s)
- Hatice Kaya
- Department of Radiology, Marmara University Pendik Training and Research Hospital, Fevzi Çakmak, MuhsinYazıcıoğlu Cd No:10 Pendik, 34899, Istanbul, Turkey
| | - Emrah Karatay
- Department of Radiology, Marmara University Pendik Training and Research Hospital, Fevzi Çakmak, MuhsinYazıcıoğlu Cd No:10 Pendik, 34899, Istanbul, Turkey.
| | - Davut Tuney
- Department of Radiology, Faculty of Medicine, Marmara University, Istanbul, Turkey
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Mishra A, Shrestha AL. Chilaiditi syndrome in a Nepalese girl - A potential mislead! Int J Surg Case Rep 2022; 91:106808. [PMID: 35151159 PMCID: PMC8858753 DOI: 10.1016/j.ijscr.2022.106808] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2022] [Revised: 01/27/2022] [Accepted: 01/30/2022] [Indexed: 11/29/2022] Open
Abstract
Introduction Chilaiditi's Sign (CS) is a radiological finding on an abdominal radiograph due to colonic interposition between the liver and the diaphragm giving a false impression of free intra peritoneal air. When accompanied by abdominal symptoms, a syndrome with the same name is diagnosed. As elusive a finding, it can be a source of diagnostic misinterpretation causing an alarming illusion of a deceptive emergency. Case presentation We report a four-year-old girl presenting with an acute abdomen in a background of long-standing constipation and an illusory radiograph suggesting left-sided, free sub diaphragmatic air. Further imaging with a CECT confirmed mesenteric lymphadenitis without free peritoneal air and chronic constipation as a cause of symptoms. Expectant management resulted in gradual clinical improvement. Discussion Chilaiditi's syndrome or CS is more often described in adults and more frequently over the right side, nevertheless, can occur in children too. Knowledge of its occurrence can avoid unnecessary surgical intervention. Conclusion While evaluating a child with acute abdomen, if the finding of a radiographic free sub diaphragmatic air is discordant with clinical signs, further imaging to rule out CS is important to avoid unnecessary exploration. Subdiaphragmatic radiolucency due to colonic interposition is termed as Chilaiditi’s sign. Chilaiditi’s sign, often described on the right side, can also occur on the left. If the clinical and radiological pictures are discordant, Chilaiditi’s syndrome should be considered. Conservative treatment has been proven to be effective in cases of Chilaiditi syndrome.
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Affiliation(s)
- Aakash Mishra
- Kathmandu Medical College Teaching Hospital, Kathmandu, Nepal.
| | - Ashish Lal Shrestha
- Department of Pediatric and Neonatal Surgery, Kathmandu Medical College Teaching Hospital, Kathmandu, Nepal
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10
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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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11
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AKSOY FD, TÜRE E, KARACA A, YURDAOR SS. Chilaiditi syndrome in a child with cerebral palsy presenting with recurrent abdominal pain. FAMILY PRACTICE AND PALLIATIVE CARE 2021. [DOI: 10.22391/fppc.874778] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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12
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Shimada H, Tago M, Tokushima M, Yamashita SI. Chilaiditi syndrome presenting with epigastric pain that improved by intentionally taking the left lateral decubitus position. J Gen Fam Med 2021; 22:53-54. [PMID: 33457159 PMCID: PMC7796780 DOI: 10.1002/jgf2.372] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Accepted: 08/17/2020] [Indexed: 11/22/2022] Open
Affiliation(s)
- Hitomi Shimada
- Department of General Medicine Saga University Hospital Saga Japan.,Shimada Hospital of Medical Corporation Chouseikai Saga Japan
| | - Masaki Tago
- Department of General Medicine Saga University Hospital Saga Japan
| | - Midori Tokushima
- Department of General Medicine Saga University Hospital Saga Japan
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13
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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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15
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Bharatam KK, Stefan S, Khan J. Robotic right hemicolectomy performed for intermittent bowel obstruction in Chilaiditi syndrome - a video vignette. Colorectal Dis 2020; 22:967-969. [PMID: 32060983 DOI: 10.1111/codi.15017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2019] [Accepted: 02/05/2020] [Indexed: 02/08/2023]
Affiliation(s)
- K K Bharatam
- Department of Colorectal Surgery, NHS Portsmouth, Queen Alexandra Hospital, Portsmouth, UK
| | - S Stefan
- Department of Colorectal Surgery, NHS Portsmouth, Queen Alexandra Hospital, Portsmouth, UK
| | - J Khan
- Department of Colorectal Surgery, NHS Portsmouth, Queen Alexandra Hospital, Portsmouth, UK
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16
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Ali F, Srinivas S, Khan HM, Reddy D. Chilaiditi Syndrome: A Rare Case of Chest Pain due to Colonic Interposition. Cureus 2020; 12:e9288. [PMID: 32832286 PMCID: PMC7437093 DOI: 10.7759/cureus.9288] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
We present an unusual case of Chilaiditi syndrome that manifests under the guise of multiple systemic signs and symptoms. An 81-year-old female patient with a history of coronary artery disease and hypothyroidism presented to emergency department (ED) with chest heaviness associated with nausea, shortness of breath, diffuse abdominal pain and constipation. Her symptoms were similar to the previous episode of ST-segment elevation myocardial infarction. The clinical team ruled out acute coronary syndrome based on electrocardiogram (EKG) and troponin levels. On further testing, CT of the abdomen revealed the interposition of colon on the dome of diaphragm consistent with Chilaiditi sign. The patient was diagnosed with Chilaiditi syndrome based on the characteristic radiological finding and the symptomatic presentation. Conservative management with bowel rest and laxative bowel regimen resolved her symptoms without further complications. A high index of suspicion is required for the early diagnosis and can prevent further complications and mitigate the need for laparoscopic intervention.
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17
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Chilaiditi sign in a plain abdominal X-ray - why is it worth remembering? GASTROENTEROLOGY REVIEW 2020; 15:82-83. [PMID: 32215134 PMCID: PMC7089854 DOI: 10.5114/pg.2020.93635] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/20/2019] [Accepted: 08/13/2019] [Indexed: 11/23/2022]
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18
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Çora AR, Çelik E. Chilaiditi Sign and Syndrome: A Rare Case Seen After Open-Heart Surgery. Ann Thorac Surg 2020; 110:e261-e263. [PMID: 32145200 DOI: 10.1016/j.athoracsur.2020.01.063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/01/2020] [Revised: 01/22/2020] [Accepted: 01/23/2020] [Indexed: 11/09/2022]
Abstract
Chilaiditi sign is a rare radiologic finding usually diagnosed incidentally. If it presents with symptoms such as nausea, vomiting, abdominal discomfort, and abdominal pain, it is called Chilaiditi syndrome. Here, we present an 81-year-old male patient who demonstrated Chilaiditi syndrome and signs after open-heart surgery.
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Affiliation(s)
- Ahmet Rıfkı Çora
- Cardiovascular Surgery Clinic, Isparta Şehir Hastanesi, Isparta, Turkey.
| | - Ersin Çelik
- Cardiovascular Surgery Clinic, Isparta Şehir Hastanesi, Isparta, Turkey
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19
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González Ávila B, Muñoz Gost N, Anton Nieto E. [Chilaiditi sign and differential diagnosis with intestinal perforation]. Rev Esp Geriatr Gerontol 2019; 54:242-243. [PMID: 30755331 DOI: 10.1016/j.regg.2018.11.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2018] [Revised: 11/05/2018] [Accepted: 11/06/2018] [Indexed: 06/09/2023]
Affiliation(s)
- Bárbara González Ávila
- Unidad de Convalecencia, Centro Sociosanitario Albada, Corporación Sanitaria ParcTaulí, Sabadell, Barcelona, España.
| | - Neus Muñoz Gost
- Unidad de Convalecencia, Centro Sociosanitario Albada, Corporación Sanitaria ParcTaulí, Sabadell, Barcelona, España
| | - Esperanza Anton Nieto
- Unidad de Convalecencia, Centro Sociosanitario Albada, Corporación Sanitaria ParcTaulí, Sabadell, Barcelona, España
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20
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Poignant S, Moënne-Loccoz J, Cohen B, Laffon M. Acute postoperative hypoxemic respiratory failure as a result of Chilaiditi's syndrome: contribution of high flow oxygen through nasal cannula. Br J Anaesth 2018; 118:465-466. [PMID: 28203744 DOI: 10.1093/bja/aex029] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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21
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Chilaiditi syndrome - a rare case of pneumoperitoneum in the emergency department: a case report. J Med Case Rep 2018; 12:263. [PMID: 30219091 PMCID: PMC6139126 DOI: 10.1186/s13256-018-1804-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2018] [Accepted: 08/14/2018] [Indexed: 12/19/2022] Open
Abstract
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.
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22
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Chilaiditi Syndrome: A Case Report Highlighting the Intermittent Nature of the Disease. Case Rep Med 2018; 2018:3515370. [PMID: 30034473 PMCID: PMC6032975 DOI: 10.1155/2018/3515370] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2018] [Revised: 05/12/2018] [Accepted: 05/29/2018] [Indexed: 11/17/2022] Open
Abstract
Background Chilaiditi syndrome is a phenomenon where there is an interposition of the colon between the liver and the abdominal wall leading to clinical symptoms. This is distinct from Chilaiditi sign for which there is radiographic evidence of the interposition, but is asymptomatic. Case Presentation Here, we present the case of a patient who, despite having clinical symptoms for a decade, had a delayed diagnosis presumably due to the interposition being intermittent and episodic. Conclusions This case highlights the fact that Chilaiditi syndrome may be intermittent and episodic in nature. This raises an interesting question of whether previous case reports, which describe complete resolution of the syndrome after nonsurgical intervention, are perhaps just capturing periods of resolution that may have occurred spontaneously. Because the syndrome may be intermittent with spontaneous resolution and then recurrence, patients should have episodic follow-up after nonsurgical intervention.
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Syed T, Farooqui S, Tajammal R, Mahmood S, Kastens D. Chilaiditi's Sign Associated with Acute Colonic Pseudo-obstruction: A Radiological Diagnosis. Cureus 2018; 10:e2351. [PMID: 29796363 PMCID: PMC5959307 DOI: 10.7759/cureus.2351] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
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.
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Affiliation(s)
- Taseen Syed
- Internal Medicine, University of Oklahoma Health Sciences Center
| | - Samid Farooqui
- Internal Medicine, University of Oklahoma Health Sciences Center
| | - Rutaba Tajammal
- Internal Medicine, University of Oklahoma Health Sciences Center
| | - Sultan Mahmood
- Gastroenterology Fellow Section of Digestive Diseases & Nutrition, University of Oklahoma Health Sciences Center
| | - Donald Kastens
- Associate Professor of Medicine Section of Digestive Diseases & Nutrition, University of Oklahoma Health Sciences Center
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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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Cawich SO, Spence R, Mohammed F, Gardner MT, Sinanan A, Naraynsingh V. The liver and Chilaiditi's syndrome: Significance of hepatic surface grooves. SAGE Open Med Case Rep 2017; 5:2050313X17744979. [PMID: 29242745 PMCID: PMC5724641 DOI: 10.1177/2050313x17744979] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2016] [Accepted: 11/06/2017] [Indexed: 11/17/2022] Open
Abstract
Chilaiditi's syndrome describes a symptomatic patient with radiographic findings of interposed colon between the diaphragm and right lobe of liver. It may mimic a pneumoperitoneum on plain radiographs. We present a case in which Chilaiditis' syndrome was entertained, delaying a decision for laparotomy. This case reinforces the diagnostic difficulty associated with Chilaiditi's syndrome, and it increases awareness of an uncommon variation in the liver surface anatomy.
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Affiliation(s)
- Shamir O Cawich
- Department of Clinical Surgical Sciences, The Faculty of Medical Sciences, University of the West Indies, St. Augustine, Trinidad & Tobago
| | - Richard Spence
- Department of Clinical Surgical Sciences, The Faculty of Medical Sciences, University of the West Indies, St. Augustine, Trinidad & Tobago
| | - Fawwaz Mohammed
- Department of Clinical Surgical Sciences, The Faculty of Medical Sciences, University of the West Indies, St. Augustine, Trinidad & Tobago
| | - Michael T Gardner
- Department of Clinical Surgical Sciences, The Faculty of Medical Sciences, University of the West Indies, St. Augustine, Trinidad & Tobago
| | - Alex Sinanan
- Department of Clinical Surgical Sciences, The Faculty of Medical Sciences, University of the West Indies, St. Augustine, Trinidad & Tobago
| | - Vijay Naraynsingh
- Department of Clinical Surgical Sciences, The Faculty of Medical Sciences, University of the West Indies, St. Augustine, Trinidad & Tobago
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Affiliation(s)
- Sohail Ghani
- Department of Paediatrics, Hywel Dda University Health Board, Glangwili General Hospital, Carmarthen, UK
| | - Christopher W Course
- Department of Paediatrics, Hywel Dda University Health Board, Glangwili General Hospital, Carmarthen, UK
| | - Hari P Bodla
- Department of Paediatrics, Hywel Dda University Health Board, Glangwili General Hospital, Carmarthen, UK
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Comparison Between Outcomes of Laparoscopic Cholecystectomy in Patients With Liver Cirrhosis or With Normal Liver Function. Int Surg 2017. [DOI: 10.9738/intsurg-d-17-00133.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Objective and Background:
The safety of laparoscopic cholecystectomy in patients with Child–Pugh A and B cirrhosis is well-established, but perioperative complications are frequently observed in patients with cirrhosis. Technical challenges of this operation in cirrhotic patients remain in need of resolution.
Methods:
Twenty-one patients preoperatively diagnosed as having cirrhosis underwent laparoscopic cholecystectomy mainly using the French approach and were retrospectively reviewed. Their clinicopathologic characteristics were compared with 74 continuous patients with gallstone but no cirrhosis who underwent laparoscopic cholecystectomy using the American approach.
Results:
Most cirrhotic patients (19/21, 90.5%) had a chronic liver disease such as hepatitis B/C, alcoholic hepatitis, or primary biliary cholangitis. On imaging, the Chilaiditi sign and gallbladder bed pocket score, previously proposed to be informative in these patients, were significantly higher in the cirrhosis group than in the no cirrhosis group. Although the Child–Pugh score was higher in patients with cirrhosis, the model for end-stage liver disease (MELD) score was similar for the 2 groups. There were no differences in the operation time or the amount of intraoperative blood transfused. Postoperative hospital stay and postoperative morbidity rates were significantly greater in the cirrhosis group, although severe complications with a Clavien–Dindo score ≥ IIIa occurred in only 1 patient in each group.
Conclusions:
The safety of laparoscopic cholecystectomy in cirrhotic patients was confirmed. Because the gallbladder is completely covered in patients with cirrhosis, the French style approach, which enables surgeons to more easily access the gallbladder pocket, is assumed to be one of the operative options.
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Affiliation(s)
- Venkatraman Indiran
- Department of Radiodiagnosis, Sree Balaji Medical College and Hospital, Chromepet, Chennai, 600044, India.
| | - Kanakaraj Kannan
- Department of Radiodiagnosis, Sree Balaji Medical College and Hospital, Chromepet, Chennai, 600044, India
| | - T Ramachandra Prasad
- Department of Radiodiagnosis, Sree Balaji Medical College and Hospital, Chromepet, Chennai, 600044, India
| | - Prabakaran Maduraimuthu
- Department of Radiodiagnosis, Sree Balaji Medical College and Hospital, Chromepet, Chennai, 600044, India
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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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Abboud ME, Frasure SE. Adult Female With Abdominal Pain. Ann Emerg Med 2017; 69:10-17. [DOI: 10.1016/j.annemergmed.2016.04.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2016] [Indexed: 11/25/2022]
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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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Affiliation(s)
- S-Y Chen
- Department of Surgery, Kaohsiung Armed Forces General Hospital, Kaohsiung, TaiwanDepartment of Internal Medicine, Kaohsiung Armed Forces General Hospital, Kaohsiung, Taiwan and Division of Hematology/Oncology, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - N-F Chen
- Department of Surgery, Kaohsiung Armed Forces General Hospital, Kaohsiung, TaiwanDepartment of Internal Medicine, Kaohsiung Armed Forces General Hospital, Kaohsiung, Taiwan and Division of Hematology/Oncology, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
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de Pablo Márquez B, Pedrazas López D, García Font D, Roda Diestro J, Romero Vargas S. [Chilaiditi's sign]. GASTROENTEROLOGIA Y HEPATOLOGIA 2016; 39:361-362. [PMID: 26817671 DOI: 10.1016/j.gastrohep.2015.12.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/11/2015] [Revised: 11/25/2015] [Accepted: 12/01/2015] [Indexed: 06/05/2023]
Affiliation(s)
| | | | | | - Jovita Roda Diestro
- Servicio de Urgencias, CUAP Sant Andreu de la Barca, Sant Andreu de la Barca, Barcelona, España
| | - Silvia Romero Vargas
- Servicio de Urgencias, CUAP Sant Andreu de la Barca, Sant Andreu de la Barca, Barcelona, España
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Colonic Interposition between the Liver and Diaphragm: "The Chilaiditi Sign". Can J Gastroenterol Hepatol 2016; 2016:2174704. [PMID: 27446829 PMCID: PMC4904707 DOI: 10.1155/2016/2174704] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2015] [Accepted: 10/04/2015] [Indexed: 12/24/2022] Open
Abstract
A 90-year-old wheelchair bound male was brought to the emergency department with complaints of worsening abdominal pain over the last 2-3 days. The patient also had difficulty in passing urine. Abdominal examination revealed tenderness in the umbilical and hypogastric area without rebound tenderness or guarding. Computed tomography (CT) of the abdomen showed a loop of colon interpositioned between the liver and the right hemidiaphragm (the Chilaiditi sign), mimicking free air. Foley's catheter was placed and the patient was managed conservatively. The patient clinically improved with improvement of the abdominal pain.
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Acute Abdomen Due to Cecal Volvulus Associated With Chilaiditi Syndrome. ACG Case Rep J 2016; 3:15-6. [PMID: 26504867 PMCID: PMC4612747 DOI: 10.14309/crj.2015.86] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2015] [Accepted: 10/10/2015] [Indexed: 11/26/2022] Open
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