Colonic interposition between the liver and left diaphragm - management of Chilaiditi syndrome: A case report and literature review

Abstract

Chilaiditi syndrome refers to a medical condition that is indicated by the presence of Chilaiditi sign, the radiological observation of a colonic interposition between the liver and the diaphragm, and is associated with other clinical symptoms. Chilaiditi syndrome is a rare entity and therefore, is often misdiagnosed in clinical practice, however, it may be accompanied by a series of severe complications, such as bowel obstruction and perforation. The current study describes a 47-year-old male who presented with repeated abdominal pain and acute intestinal obstruction. The patient was diagnosed with Chilaiditi syndrome via radiological observation and was cured by conservative treatment. The clinical data of seven additional patients with Chilaiditi syndrome, which was reported in the Chinese literature between January 1990 and January 2013, were also collected. The pathogenesis, clinical manifestation, diagnosis and treatment of this syndrome have been reviewed and analyzed. The current study may be useful to familiarize clinical practitioners with Chilaiditi syndrome, in order to avoid a misdiagnosis during clinical treatment.

Keywords: Chilaiditi sign; Chilaiditi syndrome; hepatodiaphragmatic interposition.

Figure 1

Radiological observations. (A) Plain abdominal X-ray revealed a gas shadow with visible haustral folds in the left subphrenic space (indicated by the arrow) prior to treatment. (B) Computed tomography (CT) identified an interposition of the left colon between the liver and the left diaphragm (indicated by the arrow) prior to treatment. (C and D) The gas shadow in the left subphrenic space and the colonic interposition in the CT scan disappeared following conservative treatment for one week.