Chilaiditi Sign and Chilaiditi Syndrome in Pregnancy.

BACKGROUND: Chilaiditi syndrome is a rare condition characterized by impaired fixation of the colon resulting in symptoms secondary to colonic interposition. It commonly presents with nonspecific abdominal pain and constipation, making clinical diagnosis difficult, especially in pregnancy. CASE REPORT: A 29-year-old afebrile woman in the week 28 of pregnancy presented with right-sided abdominal pain and constipation. With an Alvarado score of 6, the working diagnoses were acute appendicitis and intestinal obstruction. After a normal transabdominal ultrasound, emergent abdominal magnetic resonance imaging showed abnormal fixation of hepatic flexure wedged between the falciform ligament and liver. Without clinical, laboratory, and radiologic signs of complete obstruction or colonic perforation, conservative therapy was introduced and was successful. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Symptoms associated with Chilaiditi syndrome in pregnancy include nonspecific abdominal pain, and the correct preoperative diagnosis is difficult. The most common differential diagnoses are intestinal obstruction and acute appendicitis. It is important to diagnose Chilaiditi syndrome early because it can lead to severe complications, including intestinal obstruction, perforation, and ischemia. Therefore, in patients with right-sided abdominal pain with inconclusive transabdominal ultrasound, emergent magnetic resonance imaging leads to early diagnosis and treatment, minimizes maternal and fetal complications, avoids unnecessary explorations, and shortens the hospitalization.

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.

Duchenne muscular dystrophy with platypnea-orthodeoxia from Chilaiditi syndrome.

INTRODUCTION: Chilaiditi syndrome is a rare pathophysiology in which the colon or other organs are interposed between the diaphragm and liver, and respiratory or digestive symptoms sometimes manifest. Although there have been some cases of Chilaiditi syndrome complicating neuromuscular disorders, none have described resulting respiratory or digestive symptoms. CASE PRESENTATION: Our patient was a 20-year-old man with DMD who had been receiving noninvasive positive-pressure ventilation during the night. He experienced respiratory distress when changing from a supine to sitting position. Ventilator adjustment did not relieve the respiratory distress. Abdominal computed tomography revealed marked constipation and interposition of the transverse colon between the diaphragm and liver, indicating Chilaiditi syndrome. The right side of the diaphragm was elevated by the interposed transverse colon when the respiratory distress was present on chest radiograph, but not when symptoms were absent. The patient was diagnosed with platypnea-orthodeoxia attributed to Chilaiditi syndrome. The respiratory distress was improved by the relief of constipation, in addition to the usage of the ventilator throughout the day. CONCLUSION: The rare symptoms and pathophysiology of DMD complicated by Chilaiditi syndrome are reported and discussed herein.

Significance of Chilaiditi sign and Chilaiditi syndrome.

Chilaiditi sign and syndrome are uncommon conditions and often misdiagnosed. They are clinically significant, however, because they can result in a range of complications, including bowel volvulus, perforation and obstruction. When patients are symptomatic, treatment is usually conservative and surgery is rarely indicated unless there is a suspicion of ischaemia, or if conservative management does not resolve other signs and symptoms. This article describes Chilaiditi sign and syndrome, and presents four case studies to illustrate the relevant signs and symptoms.

Chilaiditi's sign and syndrome: theoretical facts and a case report.

INTRODUCTION: Chilaiditi's syndrome is a rare condition manifested by gastrointestinal symptoms, and radiologically verified by transposition of the large intestine loop. This radiological finding with no manifested symptoms is termed the Chilaiditi's sign. The aim of this case report was to remind the clinicians of the possibility of this rare syndrome, whose symptoms and signs may be misinterpreted and inadequately treated, with consequent diverse complications. CASE REPORT: W We presented the theoretical facts and a patient in whom the diagnosis of Chilaiditi's syndrome was established incidentally, when hospitalized for an exacerbation of his chronic obstructive pulmonary disease. The Chilaiditi's sign was verified as an incidental finding on chest X-ray performed to evaluate the primary disease. CONCLUSION: Chilaiditi's syndrome is a benign condition which rarely requires surgery. Its clinical importance lies in adequate differential diagnostic approach and timely management of potentially serious complications.

Chilaiditi's syndrome complicated by colon perforation: a case report.

Hepatodiaphragmatic interposition of the small or large intestine is known as Chilaiditi syndrome, whichis a rare disease diagnosed incidentally. Chilaiditi syndrome is typically asymptomatic, but it can be associated with symptoms ranging from intermittent, mild abdominal pain to acute intestinal obstruction, constipation, chest pain and breathlessness. A 54-year-old male patient was admitted to the hospital with a history of abdominal pain, nausea and vomiting. Chest X-ray revealed an elevation of the right hemidiaphragma caused by the presence of a dilated colonic loop below. The patient underwent urgent surgery with perforation as preliminary diagnosis. The patient underwent right hemicolectomy and ileocolic anastomosis because of the intestinal obstruction related to Chilaiditi's Syndrome. Due to the rarity of this syndrome and typical radiological findings, this case was aimed to be presented.

Chilaiditi's syndrome.

Chilaidit's syndrome is a rare condition characterised by the interposition of the colon between the liver and the right hemidiaphragm. We present a case of 20-year-old male who reported with breathlessness and epigastric pain, and he was diagnosed radiologically to have Chilaiditi's syndrome.