Surgical management of large bowel obstruction and significant hepatic displacement caused by Chilaiditi syndrome.

Chilaiditi's sign is the presence of pseudopneumoperitoneum caused by colonic distension and interposition with the liver on radiographic films. Most patients with Chilaiditi's sign are asymptomatic. Chilaiditi's syndrome is defined as the development of abdominal pain or symptoms of bowel obstruction along with the presence of Chilaiditi's sign. It is a rare entity and it poses significant diagnostic challenges due to its similar radiographic appearance to pneumoperitoneum. Most patients with Chilaiditi syndrome can be managed conservatively. However, surgery is indicated for those who do not respond to conservative management or for suspicion of severe complications such as bowel ischaemia or perforation. In this case report, we described the surgical management of a patient who presented with bowel obstruction and significant hepatic displacement from Chilaiditi syndrome.

Chilaiditi's and Ogilvie syndromes

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Chilaiditi's and Ogilvie syndromes.

We read the interesting case study of interposition of the colon between the liver and the right diaphragm (Chilaiditi's sign) that was recently reported by Ruiz Pardo et al. in a 73-year-old male with epigastric pain, ectopic cholecystitis and segmental hepatic hypoplasia. The condition was managed by laparoscopic cholecystectomy with an uneventful outcome. This sign was first described in 1910 by the Greek radiologist Demetrius Chilaiditi. The incidence of Chilaiditi's sign in plain imaging studies is from 0.025 % to 0.28 % and may be reported by abdominal computed tomography in between 1.18 % and 2.40 % of cases.

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.

Chilaiditi syndrome complicated by a sigmoid volvulus and hepatic displacement.

Chilaiditi's sign is an anatomical alteration consisting of the transposition of the small intestine or colon between the liver and diaphragm that is asymptomatic and is usually an accidental radiological finding. The onset of Chilaiditi syndrome is accompanied by clinical symptoms and is even rarer. Moreover, the combination of sigmoid volvulus and Chilaiditi syndrome is extremely rare, with only 17 previous published cases, one of which occurred in a female patient.

Treatment of Chilaiditi syndrome using laparoscopic surgery.

Chilaiditi syndrome is defined as the interposition of the bowel between the liver and right diaphragm. It is a rare disease and may be difficult to diagnose and manage. Treatment for asymptomatic patients with Chilaiditi is usually conservative and does not require surgical intervention, but surgery may be necessary if conservative treatment fails. This report describes a rare case of Chilaiditi syndrome causing small bowel obstruction and corrected using laparoscopic surgery.

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.

Surgical treatment of chronic colostasis in children: a ten-year experience.

OBJECTIVE: To analyze our ten year experience of surgical treatment of children with chronic colonostasis of different origin. MATERIAL AND METHODS: The study covers 353 children aged from 1 day to 17 years with colonic stasis who undergo treatment at the Department of Children's Surgery, Bukovinian State Medical University, Cernauti, Ukraine. Study design included case history, physical examination, routine clinical and biochemical laboratory tests, endoscopy (sigmoidoscopy, colonoscopy), X-ray (irrigoscopy, irrigography, other radiopaque techniques) methods, and sphincterometry. RESULTS: Non-surgical treatment was effective in 261 (73.94%) patients. The group of the operated patients consisted of 92 (26.06%) children. The outcome of surgical treatment of Hirschsprung's disease (49 children), dolichosigmoid (29 children), Payr's disease (12 children), and Chilaiditi syndrome in all cases is considered to be satisfactory. The optimal methods of surgical operations are offered according to pathology of colon. CONCLUSIONS: One-step Soave-Boley operation is considered to be the method of choice for rectal and rectosigmoid forms of Hirschprung's disease. Transversal colon resection and phrenico-colic ligament dissection in Payr's disease, hepatopexia and right colon fixation in Chilaiditi syndrome are effective treatment approaches.

[Chilaiditi's syndrome complicated by subdiaphragmatic perforated appendicitis: unusual manifestation of a rare condition]. / Chilaiditi-Syndrom mit subdiaphragmal perforierter Appendizitis : Ungewöhnliche Manifestation einer seltenen Erkrankung.

We report on a case of an 80-year-old female patient who presented to the emergency room of with right upper quadrant abdominal pain since the day before. During the initial diagnostic an abdominal x-ray study revealed an air-filled colonic section of the bowel under the right hemidiaphragm corresponding to Chilaiditi's sign. The clinical symptoms and laboratory results were mild at this time. After 12 h the patient developed right upper quadrant peritonitis due to a perforated, subdiaphragmatic appendicitis based on Chilaiditi's syndrome. During surgical treatment the cecum and parts of the ascending colon were found to be interposed between the liver and right hemidiaphragm. A right hemicolectomy was performed which led to complete recovery of the patient. In addition to presenting this interesting case this article highlights the regime of the diagnostics and therapy of a complication of the very rare condition of Chilaiditi's syndrome.