July 7, 2020 0 By admin

Chilaiditi syndrome is a rare condition when pain occurs due to transposition of a loop of large intestine (usually transverse colon) in between the diaphragm. Chilaiditi syndrome is the anterior interposition of the colon to the liver reaching the under-surface of the right hemidiaphragm with associated upper abdominal. Chilaiditi syndrome is a rare condition occurring in % to % of the population. In these patients, the colon is displaced and caught.

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Lu; Chilaiditi syndrome, QJM: A year-old man presented to our emergency department because of progressive epigastric pain to right upper quadrant pain, nausea, and vomiting that had persisted for 2 days. He denied specific contact and cluster history, but mentioned that he had undergone laparoscopic cholecystectomy more than 10 years prior.

No particular family history, including cancer or autoimmune disease, was traced from the interview. In his initial presentation, the patient was afebrile, with stable vital signs.

On physical syndrme, his abdomen exhibited tenderness to palpation in the epigastrum and right upper quadrant.

No signs of rebound tenderness, guarding, or ascites were observed. Decreased bowel sound was also present.


Chilaiditi syndrome | QJM: An International Journal of Medicine | Oxford Academic

Basic laboratory studies revealed mild hypokalemia 3. The results of a hepatic panel were within the normal limits. A Complete blood count demonstrated a normal syndorme. Posteroanterior chest radiography revealed the presence of air below the right side of the diaphragm Figure 1a. To exclude surgical emergencies, abdominal computed tomography was performed.

The finding revealed transverse colon interposition between liver and right diaphragm Figure 1b. Neither free air in the peritoneal cavity nor mechanical obstructive lesion was observed in the images.

The patient was diagnosed as having Chilaiditi syndrome. He then received conservative treatment with fasting, nasogastric tube decompression, and pain control, and the symptoms improved 2 days later. He was discharged uneventfully after medical therapy and remained symptom-free during 6 months of follow-up.

No extraluminal free air can be observed. Chilaiditi syndrome is extremely rare. This entity was first described by Demetrius Chilaiditi in In general, just as in our case, after conservative treatment, the symptoms may subside and urgent surgery is unnecessary. However, if Chilaiditi syndrome develops with severe complications, including mechanical bowel obstruction, mesentery ischemia, perforation, and peritonitis, emergent surgery must be considered.


In summary, abdominal pain with subphrenic free air does not always indicate surgical emergency. Combined physical examinations and detailed imaging survey could synndrome useful in making the correct diagnosis and avoiding unnecessary operation. Oxford University Press is a department of the University of Oxford. It furthers the University’s objective of excellence in research, scholarship, and education by publishing worldwide. Sign In or Create an Account.

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View large Download slide. Zur Frage der Hepatoptose und Ptose im allgemeinen im anschluss an drei Falle von temporarer, partieller Leberverlagerung. Colonic interposition between the liver and left diaphragm – management of Chilaiditi syndrome: For Permissions, please email: Email alerts New issue alert. Receive exclusive offers and updates from Oxford Academic. Related articles in PubMed Chilaiditi syndrome. Viscerohepatodiaphragmatic interposition Chilaiditi’s syndrome in a child.

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