ABSTRACT

Chilaiditi’s sign is the anatomical description of the interposition of the colon between the liver and the diaphragm; when it is accompanied with clinical symptoms, it is known as Chilaiditi’s syndrome. Most commonly, it is an asymptomatic radiological finding and is considered a rare entity, and therefore, it is often misdiagnosed in clinical practice; however, it may be accompanied by a series of severe complications. Here we report a patient with Chilaiditi’s syndrome, owing to its rarity, and the typical radiological findings of this syndrome. A 22-year-old female was admitted to the hospital, presenting with a 2-day history of nausea and worsening right upper quadrant pain. Vital signs were stable. The physical examination revealed a soft abdomen with mild right upper abdominal tenderness. Laboratory assays showed no abnormalities. A plain abdominal X-ray showed an abnormal gas shadow in the subhepatic space and a segment of gaseous distended colon. A computarized tomography (CT) scan of the abdomen showed a loop of colon interpositioned between the liver and the right hemidiaphragm, mimicking free air. The patient consulted with a general surgery physician, and was admitted to the general surgery service to follow up on treatment and operation, if indicated. The patient was managed conservatively. During the course of her hospital stay, her abdominal pain resolved without surgical intervention. She was then able to tolerate a regular diet, and was discharged after two days of hospital stay. Although Chilaiditi’s syndrome is not common, it is important, and can be easily mistaken for pneumoperitoneum. Most of the cases with Chilaiditi’s syndrome can be resolved with nasogastric decompression and repeated laxatives. Surgical intervention is reserved for patients with signs of systemic toxicity or peritonitis. Owing to the rarity of this syndrome and its typical radiological findings, we aimed to present this case.

Keywords: Chilaiditi’s syndrome, abdominal pain, colon interposition