Title: Chilaiditi Syndrome Complicated by a Small Bowel Obstruction
Authors: Oussama Othmane Lakhlifi, Mohammed Anwar Hmamouche, Omar Marghich
Volume: 8
Issue: 8
Pages: 48-51
Publication Date: 2024/08/28
Abstract:
Chilaiditi sign is a rare incidental radiographic finding where bowel is interposed between the diaphragm and the liver, often appearing as air under the right hemidiaphragm. Most patients with Chilaiditi sign are asymptomatic and remain so throughout their lives. When Chilaiditi sign becomes symptomatic, it is referred to as Chilaiditi syndrome, a very rare cause of bowel obstruction. Given the significant financial burden of bowel obstruction on the healthcare system, studying even rare etiologies is valuable. In Chilaiditi syndrome, the presence of free air under the right hemidiaphragm can mistakenly suggest pneumoperitoneum, leading to unnecessary emergent surgical evaluations. By considering a broad differential diagnosis and clinical presentation, physicians can avoid inappropriate allocation of resources and unnecessary surgeries. Keeping Chilaiditi syndrome in the differential diagnosis can help prevent unnecessary interventions, reduce patient costs, and avoid complications. Typically, bowel obstruction due to Chilaiditi syndrome is managed conservatively with intravenous fluids, bowel rest, decompression, and laxatives. Surgical intervention may be required if symptoms worsen and progress to complete bowel obstruction, with positive outcomes often observed. We report a case of a 64-year-old male who presented to the emergency department with a 5-day history of right-sided abdominal pain, obstipation, and vomiting. CT imaging incidentally revealed colonic interposition with mild colonic dilatation. The patient was diagnosed with small bowel obstruction secondary to Chilaiditi syndrome and underwent surgical treatment with a rapid recovery.