CHILAIDITIS SINDROME PDF

Chilaiditi syndrome is a rare condition occurring in 0. In these patients, the colon is displaced and caught between the liver and the right hemidiaphragm. Patients' symptoms can range from asymptomatic to acute intermittent bowel obstruction. Diagnosis is best achieved with CT imaging. Identification of Chilaiditi syndrome is clinically significant as it can lead to many significant complications such as volvulus, perforation, and bowel obstruction.

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Over a century ago, the radiologist Demetrius Chilaiditi reported a small case series of 3 patients with the incidental radiologic finding of colonic interposition between the liver and diaphragm.

Under normal conditions, suspensory ligaments and fixation of the colon impede interposition of the colon between the liver and diaphragm. However, variations in normal anatomy can lead to the pathologic interposition of the colon. These anatomic variations can include the absence, laxity, or elongation of the suspensory ligaments of the transverse colon or the falciform ligament, as well as dolichocolons or congenital malpositions.

Anatomic distortions can also result from functional disorders such as chronic constipation colonic elongation and redundancy , aerophagia gaseous distension of the colon , cirrhosis liver atrophy or relative atrophy in the medial segment of the left lobe of the liver , diaphragmatic paralysis, chronic lung disease enlargement of the lower thoracic cavity , obesity, multiple pregnancies, and ascites increased intra-abdominal pressure.

Mental retardation and schizophrenia are also associated with anatomic abnormalities that result in Chilaiditi sign. Colonic interposition is usually an asymptomatic radiologic sign.

In patients presenting with Chilaiditi syndrome, the most common symptoms are gastrointestinal eg, abdominal pain, nausea, vomiting, and constipation , followed by respiratory distress and, less frequently, anginalike chest pain.

Complications of Chilaiditi syndrome may include a volvulus of the cecum, splenic flexure, or transverse colon. Chilaiditi syndrome should be considered as a rare cause of intestinal obstruction of either the large or small bowel, as reported by Mateo de Acosta Andino and associates. Colonic interposition Chilaiditi sign is defined by the presence of air below the right diaphragm on a radiograph.

To diagnose Chilaiditi sign based upon radiologic findings, the following criteria must be met: The right hemidiaphragm must be adequately elevated above the liver by the intestine, the bowel must be distended by air to illustrate pseudopneumoperitoneum, and the superior margin of the liver must be depressed below the level of the left hemidiaphragm.

The finding of normal plicae circulares or haustral markings of the colon under the diaphragm can rule out these more serious entities. Moreover, changing the position of a patient with Chilaiditi sign will not change the position of the radiolucency, unlike in a patient with free air. Similarly, when using ultrasound, altering the position of a patient with Chilaiditi sign will not lead to a change in the location of the gas echo, as opposed to a patient with pneumoperitoneum. The differential diagnoses of Chilaiditi syndrome can also include bowel obstruction, volvulus, intussusception, ischemic bowel, or infammatory conditions eg, appendicitis or diverticulitis.

However, as mentioned above, these intestinal disorders can also occur within the interposed colon in rare instances. Chilaiditi syndrome can be initially misdiagnosed as a diaphragmatic hernia. No intervention is required for an asymptomatic patient with Chilaiditi sign.

When evaluating a symptomatic patient with small bowel obstruction, clinicians should first rule out the more serious condition of pneumoperitoneum. On the other hand, a misdiagnosis of bowel perforation might result in unnecessary surgical intervention. It is important to identify Chilaiditi sign in order to prevent complications from occurring during a percutaneous transhepatic procedure or liver biopsy, particularly in cirrhotic patients, who are predisposed to development of Chilaiditi sign.

An interposed segment of bowel can also make it very diffcult to perform a colonoscopy. Administration of carbon dioxide as the insufflating agent for colonoscopy is appropriate for decreasing this risk. Initial management of Chilaiditi syndrome should include bed rest, intravenous fluid therapy, bowel decompression, enemas, and laxatives. A repeat radiograph following bowel decompression may show disappearance of the air below the diaphragm.

Tus, bowel decompression documented by a follow-up radiograph can confirm both the diagnosis of the condition and the success of the therapy, by showing the disappearance of subdiaphragmatic air and repositioning of distended intestine back to the normal position beneath the liver.

If the patient does not respond to initial conservative management, and either the obstruction fails to resolve or there is evidence of bowel ischemia, then surgical intervention is indicated. In recent years, surgical intervention has been increasingly used in order to manage symptoms of chronic, intermittent abdominal pain. Cecopexy may be adequate to eliminate the possibility of recurrence in an uncomplicated cecal volvulus, unless gangrene or perforation necessitates surgical resection.

National Center for Biotechnology Information , U. Gastroenterol Hepatol N Y. Author information Copyright and License information Disclaimer. Corresponding author. Address correspondence to: Dr. Richard A. This article has been cited by other articles in PMC. References 1. Chilaiditi D. Image of the month. Chilaiditi sign or syndrome. Arch Surg. Am J Gastroenterol.

An elderly man with chest pain, shortness of breath, and constipation. Postgrad Med J. Surg Gynecol Obstet. The Chilaiditi syndrome and associated volvulus of the transverse colon [in Spanish] Rev Gastroenterol Peru. Lekkas CN, Lentino W. Symptom-producing interposition of the colon. Clinical syndrome in mentally deficient adults. Splenic flexure volvulus in association with Chilaiditi syndrome: report of a case. Am Surg.

Ansari H, Lay J. Chilaiditi syndrome and associated caecal volvulus. ANZ J Surg. Transverse colon volvulus and Chilaiditi syndrome: an exceptional association. Chilaiditi syndrome complicated by cecal perforation. South Med J. Dyspnea and large bowel obstruction: a misleading Chilaiditi syndrome. Am J Surg. Chilaiditi syndrome complicated by a closed-loop small bowel obstruction.

Gastroenterol Hepatol N Y ; 8 — Colonic pseudo-colonic obstruction Ogilvie syndrome in a patient with Chilaiditi syndrome [in Spanish] Cir Esp. Melester T, Burt ME. Report of three cases. Yagnik VD. Chilaiditi syndrome with carcinoma rectum: rare entity. Saudi J Gastroenterol. Sendon JL. Primary lung cancer and the Chilaiditi syndrome.

Chilaiditi syndrome: sonographic findings. Abdom Imaging. Clinical quiz. J Pediatr Gastroenterol Nutr. Ann Torac Surg. Morgagni revisited: a case of intermittent chest pain. Br J Radiol. Vallee PA. Symptomatic morgagni hernia misdiagnosed as Chilaiditi syndrome. West J Emerg Med. Air under the right diaphragm: colonoscopy in the setting of Chilaiditi syndrome. Gastrointest Endosc. Minimally invasive colopexy for pediatric Chilaiditi syndrome.

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Chilaiditi Syndrome

Metrics details. 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. We present a rare case of a 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. 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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Acute Abdominal Pain Secondary to Chilaiditi Syndrome

Over a century ago, the radiologist Demetrius Chilaiditi reported a small case series of 3 patients with the incidental radiologic finding of colonic interposition between the liver and diaphragm. Under normal conditions, suspensory ligaments and fixation of the colon impede interposition of the colon between the liver and diaphragm. However, variations in normal anatomy can lead to the pathologic interposition of the colon. These anatomic variations can include the absence, laxity, or elongation of the suspensory ligaments of the transverse colon or the falciform ligament, as well as dolichocolons or congenital malpositions. Anatomic distortions can also result from functional disorders such as chronic constipation colonic elongation and redundancy , aerophagia gaseous distension of the colon , cirrhosis liver atrophy or relative atrophy in the medial segment of the left lobe of the liver , diaphragmatic paralysis, chronic lung disease enlargement of the lower thoracic cavity , obesity, multiple pregnancies, and ascites increased intra-abdominal pressure. Mental retardation and schizophrenia are also associated with anatomic abnormalities that result in Chilaiditi sign. Colonic interposition is usually an asymptomatic radiologic sign.

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

Chilaiditi syndrome is the anterior interposition of the colon to the liver reaching the under-surface of the right hemidiaphragm with associated upper abdominal pain; it is one of the causes of pseudopneumoperitoneum. Colonic gas in this position may be misinterpreted as true pneumoperitoneum resulting in further imaging, investigation, and treatment that is not required. Pain distinguishes Chilaiditi syndrome from asymptomatic colonic interposition, which is termed as Chilaiditi sign. This is by virtue of the fact that syndrome is a collection of signs and symptoms. Features that suggest a Chilaiditi syndrome i.

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