Differentiating Chilaiditi’s Syndrome with hollow viscus perforation: A case report

• Published in: International journal of surgery case reports Vol. 78; pp. 314 - 316
• Main Authors: Sofii, Imam, Parminto, Zakariya Aji, Anwar, Sumadi Lukman
• Format: Journal Article
• Language: English
• Published: Netherlands Elsevier Ltd 01.01.2021; Elsevier
• Subjects: Case Report; Chilaiditi’s sign; Chilaiditi’s syndrome; Colonic interposition; Pseudoperitoneum; Chilaiditi’s syndrome; Pseudoperitoneum; Colonic interposition; Chilaiditi’s sign
• ISSN: 2210-2612; 2210-2612
• DOI: 10.1016/j.ijscr.2020.12.029

•Its important to understand the unique characteristic of the sign, symptoms and findings of Chilaiditi’s Syndrome.•Chilaiditi’s Syndrome often misdiagnosed with hollow viscus perforation which can lead to unnecessary treatment.•Conservative treatment has proven to be effective for patient that have Chilaiditi’s Syndrome without any complication. Chilaiditi‘s syndrome is a rare condition accounting for only 0.25%–0.28% of all abdominal imaging worldwide. To rule out Chilaiditi‘s syndrome from other acute abdominal emergencies is very important to avoid unnecessary treatment or surgical procedure. A 25-year-old female presented in the emergency room with 1 week history of abdominal discomfort. At time of examination, she had a mild shortness of breath that was not related with rigorous activities. A plain abdominal x-ray was suggested the presence of an air-filled bowel tract within the right subphrenic space (Fig. 1). Abdominal computed tomography suggested colonic loop present between the right hemi-diaphragm and liver. The absence of abdominal free air confirmed an isolated pseudo-pneumoperitoneum due to colonic interposition between the liver and diaphragm. Chilaiditi sign is radiolucency in the subdiaphragmatic space as a result of bowel interposition between a diaphragm and the liver. If gastrointestinal symptoms present, the condition is known as Chilaiditi's syndrome. The abdominal symptoms including severe pain, anorexia, diarrhea, nausea, vomiting, bloating and constipation might mislead physicians or surgeons with diaphragmatic hernia, subdiaphragmatic abscess, bowel perforation, infected hydatid cyst and liver tumor. Thorough physical examination, imaging, and timely follow up is very important to avoid unnecessary exploratory laparotomies. Chilaiditi’s Syndrome is often misdiagnosed with bowel perforation because the presence of pseudopneumoperitoneum in the plain X-Rays. It is important to understand the unique characteristics of the sign, symptoms and findings of Chilaiditi’s Syndrome to prevent unnecessary surgical procedures.