Chilaiditi Syndrome Research Articles

Chilaiditi syndrome—a clinical conundrum!

Over a century ago, radiologist Demetrius Chilaiditi reported a case series of three patients with the incidental radiological finding of colonic interposition between the liver and diaphragm. Ther...

Chilaiditi sign as an incidental finding in a patient with respiratory disease: a case report

El signo de Chilaiditi es un hallazgo radiográfico infrecuente que consiste en la interposición de un asa intestinal entre el hígado y el diafragma. No existe etiología claramente establecida; sin embargo, se han planteado varias hipótesis que explican su presencia, entre ellos la hiperlaxitud de los ligamentos suspensorios del hígado, el aumento de la presión intraabdominal y la redundancia colónica. Al asociarse este hallazgo con síntomas gastrointestinales o respiratorios se denomina síndrome de Chilaiditi, y su tratamiento principalmente es sintomático, en casos excepcionales requiere abordaje quirúrgico. Este signo se encuentra usualmente de manera incidental y se ha visto una relación con enfermedad respiratoria crónica; pudiendo afectar su curso clínico, motivando a profundizar en el estudio integral. Se presenta el caso de un paciente adulto mayor, en seguimiento médico por enfermedad pulmonar obstructiva crónica, cuya radiografía de tórax evidencia la interposición de un asa intestinal entre la cúpula diafragmática derecha y el hígado. MÉD.UIS. 2018;31(3):57-61.

Chilaiditi syndrome \u2013 a rare case of pneumoperitoneum in the emergency department: a case report

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.

DUCHENNE MUSCULAR DYSTROPHY – CLINICAL: P.29Analysis of respiratory function of Duchenne muscular dystrophy with Chilaiditi syndrome

DUCHENNE MUSCULAR DYSTROPHY – CLINICAL: P.29Analysis of respiratory function of Duchenne muscular dystrophy with Chilaiditi syndrome

Chilaiditi Syndrome—What's Air Doing There?

Chilaiditi Syndrome—What's Air Doing There?

Chilaiditi syndrome

Chilaiditi syndrome

Psychiatric patient with Chilaiditi's syndrome.

Chilaiditi's sign is defined as the interposition of bowels between the liver and the right diaphragm. When the patient is symptomatic due to the intestinal obstruction, the case is referred to as Chilaiditi's syndrome. To emphasize the importance of accurate diagnose of Chilaiditi's syndrome in patients with psychotic disturbances. A 46 years old male was admitted to our department suffering from a constant epigastric and right upper quadrant pain with radiation to the right shoulder. The pain started 10 hours before the admission of the patient and was accompanied with vomiting. Patient has a history of schizophrenia and intellectual disability. He was in a stimulatory situation and unable to give any information about his state of health. Patient was afebrile, tachycardic and laboratory results were normal. The chest and abdomen x-ray showed the Chilaiditi's sign. With the ultrasound procedure the case of the pneumoperitoneum was excluded. A conservative treatment with IV fluid hydration, pain management, diet modification, laxatives and enemas, was used. After a week of hospitalization, the patient felt well, having proper diet and regular evacuations and at the Chilaiditi's sign was no more observed. The etiology of the Chilaiditi's syndrome is multifactoral and it has been reported that it is associated with psychotropic medication and intellectual disability. The diagnosis of the syndrome is vital in order to avoid unnecessary and dangerous surgical interventions. Only few publications of a Chilaiditi syndrome in patients with psychosis are cited in the literature.

Multiple Primary Malignant Neoplasms in the Presence of Concomitant Chilaiditi Syndrome

Multiple Primary Malignant Neoplasms in the Presence of Concomitant Chilaiditi Syndrome

Chilaiditi's Syndrome Causing High-Grade Small-Bowel Obstruction Requiring Exploratory Laparotomy.

Chilaiditi's sign is a radiological finding that occurs when the small or large intestine is positioned superior to the liver in the sub-diaphragmatic space. This is typically an asymptomatic radiological sign, but when symptoms occur, e.g., abdominal pain, nausea, emesis, it is termed Chilaiditi's syndrome. Currently, majority of the cases of Chilaiditi's syndrome, described in the literature, requiring operative intervention are due to large bowel obstruction or colonic volvulus. The following is a single case report of a patient presenting to Keesler Medical Center in Biloxi, Mississippi. This report details a 57-yr-old female who has found to have Chilaiditi's syndrome causing a high-grade small-bowel obstruction. She failed non-operative intervention and required exploratory laparotomy, lysis of adhesions, and manual reduction of small bowel from the sub-diaphragmatic space. The rate of failure of non-operative management of Chilaiditi's syndrome has not been established. Our patient had a surgical history of laparotomy and was found to have adhesions superior to her liver. Patients with prior abdominal surgery may require a lower threshold for operative management for Chilaiditi's syndrome due to the possibility of concomitant adhesive disease particularly if the prior procedure involved the upper abdomen.

Chilaiditi Syndrome: A Rare Cause of Shortness of Breath and Abdominal Pain

Introduction: Chilaiditi syndrome is a rare condition in which a segment of the small or large intestine is interposed in between the diaphragm and the liver. This case report presents a patient who was admitted to the Department of Emergency Medicine, Turgut Ozal Medical Center with complaints of respiratory distress and abdominal pain and then diagnosed with Chilaiditi syndrome.Case Report: An 81-year-old female patient was admitted to the emergency department with complaints of difficulty in breathing and abdominal pain. The patient’s anamnesis indicated that difficulty of breathing increased when she had abdominal pain. There was no defense or rebound, but sensitivity was observed on abdominal examination. Other system examinations were normal. Abdominal ultrasonography performed on the patient was also normal. A dynamic thorax-abdominal tomography was obtained in terms of differential diagnosis of the patient who had abdominal pain. In the dynamic thorax-abdominal tomography of the patient, loops of the colon were visualized in the vicinity of the liver anterior segment, and these images indicated with Chiliaditi syndrome.Conclusion: As a result, when the causes of shortness of breath and abdominal pain are investigated, Chiliaditi syndrome should be considered as a differential diagnosis

When a Warning Sign is Not a Warning Sign: Chilaiditi's Sign in a Patient with Heart Failure and Epigastric Hernia

Malposition of hepatic flexure of colon in sub diaphragmatic space, Chilaiditi syndrome, is usually an asymptomatic anatomical aberrancy of position. It is usually noted as a coincidental finding in chest X-ray. We present a case of 63 years old male who presented as an outpatient in the department of general medicine in rural hospital. The patient had features of heart failure and also had Chilaiditi syndrome as an incidental finding. This case is presented to remind ourselves of a harmless condition in the myriad of grave conditions that account for gas under the diaphragm in a chest X-ray. Birat Journal of Health SciencesVol.2/No.3/Issue 4/Sep- Dec 2017, Page: 300-302

Case of Chilaiditi syndrome in a critically ill patient

Chilaiditi sign, a condition first described by Greek radiologist Demetrius Chilaiditi in 1910, is the radiological appearance of colonic interposition between the liver and the diaphragm. The incidence in chest/abdominal x-rays and CT scans is 0.025 – 0.28%. When there are symptoms, such as abdominal pain, nausea, constipation or respiratory distress, the condition is called Chilaiditi's syndrome. One of the key factors in the development of this anomaly is anatomic variation in the suspensory ligaments of the intestines. Other important etiological factors include aerophagia, constipation, liver cirrhosis and chronic lung disease with increased intrathoracic pressure. Below we discuss a case of Chilaiditi's syndrome in an elderly female, who presented with shortness of breath, constipation and abdominal distention. The diagnosis of Chilaiditi's syndrome was made by chest x-ray and CT scan.

Chilaiditi Syndrome Complicated by Cecal Perforation in the Setting of Scleroderma.

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.

A Case of Cecal Volvulus Complicated by Chilaiditi Syndrome

A Case of Cecal Volvulus Complicated by Chilaiditi Syndrome

Comparison Between Outcomes of Laparoscopic Cholecystectomy in Patients With Liver Cirrhosis or With Normal Liver Function

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.

Chilaiditiʼs Syndrome: Unusual Cause of Abdominal Pain

Background: Chilaiditi syndrome is the association of Chilaiditi sign with clinical symptoms including gastrointestinal, respiratory, or cardiac systems. Chilaiditi sign is the finding of colon between the diaphragm and liver on radiographic imaging, mimicking the appearance of air under the diaphragm. Clinical symptoms typically seen include nausea/vomiting, abdominal pain, and constipation. Here, we present a case of Chilaiditi syndrome that was diagnosed during workup for vague abdomen pain. Case Description: An 83 year old female with medical history of hypertension, type 2 diabetes mellitus, osteoporosis, rheumatoid arthritis, deep vein thrombosis with an IVC filter who complained of diffuse abdominal pain with occasional non-bloody vomiting for the 1 month duration. She also complained of chronic constipation and usually has only 1 to 2 bowel movements a week. Patient did not complain of any other symptoms. Initial exam revealed abdomen that was soft with diffuse tenderness upon palpation without any guarding or rebound. Rectal vault was full of formed stool. Vital signs and all other parts of physical exam were within normal limits. Initial abdominal x-ray showed possible air under the diaphragm. A follow-up CT scan of the abdomen/pelvis showed dilated rectum measuring 9.7 cm. The hepatic flexure was noted to be between the liver and the right diaphragm, suggestive of Chilaiditi syndrome (Fig. 1 and 2). Patient was manually disimpacted, which improved her symptoms. She declined additional workup with colonoscopy. Finally, she was given polyethylene glycol17 mg PO daily or BID, high fiber diet and was discharged home. Discussion Abdominal pain and emesis for a month along with finding of hepatic flexure located between the right diaphragm and the liver makes this case presentation a rare case of Chilaiditi syndrome. The exact etiology of this condition is not fully understood, however it is more commonly noted in patients with dolichocolon, COPD, hepatic atrophy. The plain x-ray findings of pneumoperitoneum could be confused for bowel perforation and CT scan of abdomen will help to differentiate it from Chilaiditi syndrome. Complications of Chilaiditi syndrome include volvulus or perforation of the transverse colon, ascending colon and cecum and can also lead to sub-diaphragmatic appendicitis. Management of Chilaiditi syndrome includes intravenous fluids, decompression of the bowel, stool disimpaction and enemas.FigureFigure: Hepatic flexure located between the liver and the right diaphragm.

Chilaiditi Syndrome Complicated by Cecal Perforation in Setting of Scleroderma-Induced Bowel Wall Weakening: A First Reported Case of Its Kind

Chilaiditi Syndrome Complicated by Cecal Perforation in Setting of Scleroderma-Induced Bowel Wall Weakening: A First Reported Case of Its Kind

EUS-guided drainage of hepatic abscess in the right side of the liver of a patient with Chilaiditi syndrome.

EUS-guided drainage of hepatic abscess in the right side of the liver of a patient with Chilaiditi syndrome.

Pneumopathie grave mortelle compliquant un syndrome de Chilaiditi

Pneumopathie grave mortelle compliquant un syndrome de Chilaiditi

Liver surface anomaly: report of a new association with Chilaiditi's syndrome

Liver surface anomaly: report of a new association with Chilaiditi's syndrome