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. 2014;5(6):335-8.
doi: 10.1016/j.ijscr.2014.03.011. Epub 2014 Mar 31.

Chilaiditi's syndrome associated with colonic volvulus and intestinal malrotation-A rare case

A Williams  1 , R Cox  1 , B Palaniappan  1 , A Woodward  2
Affiliations

Chilaiditi's syndrome associated with colonic volvulus and intestinal malrotation-A rare case

A Williams et al. Int J Surg Case Rep. 2014.

Abstract

Introduction: Chilaiditi's syndrome (symptomatic hepatodiaphragmatic interposition of the colon) is an exceptionally rare cause of bowel obstruction and may present difficulty in diagnosis and management. This is the first reported case of colonic volvulus occurring in Chilaiditi's syndrome in association with intestinal malrotation and this case study describes its successful management.

Presentation of case: An 18 year old male presented as an emergency with vague abdominal pain and a past history of gastroschisis repair with intestinal malrotation. CT scanning showed a closed loop obstruction due to a volvulus of the colon herniating under the falciform ligament. The patient was successfully treated by surgical reduction of the hernia, anatomical correction of the malrotation and caecopexy with a tube caecostomy. At six month follow up the patient was well and asymptomatic.

Discussion: In nine of the previously reported cases of Chilaiditi's syndrome with colonic volvulus, treatment was by partial colonic resection of which a third underwent stoma formation. One patient died as a consequence of anastomotic leak following primary anastomosis. We therefore suggest an alternative approach to management.

Conclusion: Chilaiditi's syndrome with colonic volvulus in association with intestinal malrotation has not previously been described. As there is no consensus in the literature as to how to manage such a case we suggest that reduction of the volvulus, anatomical correction of the malrotation and fixation of the caecum by tube caecostomy results in a successful outcome. This approach avoids the need for colonic resection and possible stoma formation.

Keywords: Adult malrotation; Chilaiditi's syndrome; Colonic volvulus; Internal hernia; Nonrotation.

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Figures

Fig. 1
Fig. 1
CT scannergram showing caecum lying in the left iliac fossa with volvulus of the colon in the right subdiaphragmatic space.
Fig. 2
Fig. 2
CT scan showing volvulus of the colon with closed loop obstruction compressing the left lobe of the liver.
Fig. 3
Fig. 3
CT scan showing inversion of the superior mesenteric artery (SMA) and the superior mesenteric vein (SMV).
Fig. 4
Fig. 4
CT scan showing ileocaecal valve and caecum on the left side and small bowel on the right.
See this image and copyright information in PMC

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