Abstract
BackgroundPneumoperitoneum 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 presentationWe 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.ConclusionsA 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.
Highlights
Pneumoperitoneum poses an important diagnostic sign determining the urgency of management of patients in an emergency department
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
Chilaiditi sign is a rare radiologic finding where colonic interposition occurs between the diaphragm and the liver: hepatodiaphragmatic interposition [1]
Summary
This case highlights the importance of treating the patient as a human rather than numbers and images. Medical students are taught that air under the diaphragm is always a surgical emergency. It almost always is, but a thorough physical examination that does not show signs of peritonitis should prompt further investigations to understand the underlying pathology. Competing interests The authors declare that they have no competing interests. Author details 1Faculty of Medicine, Ain Shams University, Cairo, Egypt. Author details 1Faculty of Medicine, Ain Shams University, Cairo, Egypt. 2Cleveland Clinic Foundation, Cleveland, OH, USA. 3Clinical Oncology Department, Faculty of Medicine, Ain Shams University, Lofty Elsayed Street, Cairo 11566, Egypt. 4Faculty of Medicine, Damascus University, Damascus, Syria. 5Clinical Oncology Department, Faculty of Medicine, Damascus University, Damascus, Syria. 6Department of Emergency Medicine, Al Ain Hospital, Al Ain, United Arab Emirates
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