Chilaiditi Syndrome: The Pitfalls of Diagnosis

Chien-Hua Lin³, Jyh-Cherng Yu², Jing-Jim Ou³, Yueh-Tsung Lee³, Mei Huang¹, Hurng-Sheng Wu³

¹Department of Medicine, Chang-Bing Show Chwan Memorial Hospital, Changhua.
²Division of General Surgery, Department of Surgery, Tri-Service General Hospital, Chinese Taipei.
³General Surgery Department, Chang-Bing Show Chwan Memorial Hospital, Changhua; IRCAD Taiwan, Chang-Bing Show Chwan Memorial Hospital, Changhua.

DOI: 10.4236/ss.2012.33028                

Abstract

Purpose: Chilaiditi’s syndrome is the hepatodiaphragmatic interposition of the colon. Its diagnosis poses challenge to clinicians, and misdiagnosis may results in unnecessary exploratory laparotomy being performed. The purpose of this study was to report our experience in diagnosis, management, and clinical outcome of patients with Chilaiditi’s syndrome. Methods: Nine cases of Chilaiditi’s syndrome from April 2005 to January 2007 at one institute. The clinical characteristic, imaging studies, management and results were recorded. Results: Six patients presented with abdominal distension (2 patients with abdominal pain; 5 patients with constipation), while Chilaiditi’s syndrome in the other three patients were found incidentally. All patients underwent chest X-ray. The Chilaiditi’s sign could be detected in seven patients; while the other two patients presented with no specific finding. Abdominal plain films (KUB) were all reviewed. Most of the patients (n = 8) showed ileus and one patient showed no specific finding. Impacted stool could be detected in five of nine patients. Abdominal ultrasound was performed in two patients. Gallstones were detected in one of them while the other revealed no specific finding. Six of nine patients underwent CT of abdomen, one of them revealed bowel loops in bilateral subphrenic space. One patient underwent subtotal colectomy because of volvulus of sigmoid colon. Five patients were treated with laxative and enema successfully and had been remained asymptomaticcally for a mean follow-up of 6.6 months. The other three cases were under observation. Conclusions: Presence of haustral folds of bowel loops may help us in diagnosing Chilaiditi’s syndrome. The left lateral decubitus abdominal plain film can also help to differentiate between pneumoperitoneum to Chilaiditi’s sign. Most of the cases with Chilaiditi’s syndrome can be resolved with conservative treatment and surgical intervention was reserved for patients with sign of systemic toxicity or peritonitis.

Keywords

Chilaiditi Syndrome; Hepatodiaphragmatic Interposition; Chilaiditi

Conflicts of Interest

The authors declare no conflicts of interest.

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