Gut Entrapped in the Thorax: A Rare Presentation of Abdominal Pain in Chilaiditi Syndrome

Chilaiditi Syndrome: A Case Report, Literature Review, and Proposition of a Novel Management Staging System

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.

Chilaiditi Sign in a Patient With Acute Coronary Syndrome: A Case Report

Chilaiditi sign is a radiographic finding where part of the colon is found to be between the diaphragm and liver. Chilaiditi syndrome is characterized by symptoms such as chest or abdominal pain and shortness of breath once Chilaiditi sign is found on imaging. Chilaiditi sign is typically diagnosed by CT angiography (CTA) scan although it can also be seen on X-ray imaging at times. In most cases, Chilaiditi sign does not require acute intervention, as will be seen in our patient; however, it is important to include it in the differential diagnosis when a patient presents with characteristic symptoms. We present a case of a 71-year-old female who presented with chest pressure and shortness of breath due to acute coronary syndrome; however, she was found to have Chilaiditi sign, which was diagnosed by CTA chest.

Thoracic Gut Entrapment Presenting As Intractable Hypoxia: A Case Report of Chilaiditi Syndrome

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. 

Chilaiditi's and Ogilvie syndromes

We read the interesting case study of interposition of the colon between the liver and the right diaphragm (Chilaiditi's sign) that was recently reported by Ruiz Pardo et al. in a 73-year-old male with epigastric pain, ectopic cholecystitis and segmental hepatic hypoplasia. The condition was managed by laparoscopic cholecystectomy with an uneventful outcome. This sign was first described in 1910 by the Greek radiologist Demetrius Chilaiditi. The incidence of Chilaiditi's sign in plain imaging studies is from 0.025 % to 0.28 % and may be reported by abdominal computed tomography in between 1.18 % and 2.40 % of cases.

Chilaiditi syndrome: an unusual presentation in elderly man

Chilaiditi syndrome is a radiological manifestation of a large bowel interposition between the liver and right hemidiaphragm that associated with gastrointestinal symptoms. We report a case of 78-year-old Saudi male with multiple comorbidities, presented to the emergency department with two episodes of passaging a large amount of fresh, bright blood per rectum. Later, the patient was diagnosed with Chilaiditi syndrome and managed with conservative measures. The presence of Chilaiditi signs can be caused by an abnormality of either liver, colon or right hemidiaphragm that leads to sub-diaphragmatic space enlargement or intestinal hypermobility. Computed tomography imaging is the best diagnostic modality. Conservative treatment is the first line in management.

Chilaiditi's Sign: A Case Report

Chilaiditi’s sign refers to the interposition of the colon (usually the transverse colon) between the diaphragm and the liver. When associated with abdominal pain it is referred to as Chilaiditi’s syndrome. Chilaiditi’s sign is rare entity with an estimated incidence of 0.025 to 0.28% worldwide. The sign occurs more frequently in males, with a male to female ratio of 4:1. Apparent pneumoperitoneum seen on imaging below the right hemidiaphragm, a life-threatening condition, may in fact be merely Chilaiditi’s sign. Awareness of this phenomenon and its consideration as a differential diagnosis is essential to prevent unnecessary laparoscopic intervention.

Here we present a case of a 74-year-old male who was incidentally found to have free air under the diaphragm without symptoms of abdominal pain. After further evaluation by the radiologists and surgeons it was concluded that he had Chilaiditi’s sign and no further intervention was required. However, due to the lack of awareness of this radiographic finding patients can be subjected to unnecessary surgical intervention.