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Saha B, Verma A, Coelho-Prabhu N, Kelm ZS, Cabrera D. Chilaiditi Syndrome Masquerading as Acute Cholecystitis. ACG Case Rep J 2024; 11:e01448. [PMID: 39035204 PMCID: PMC11259379 DOI: 10.14309/crj.0000000000001448] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2024] [Accepted: 06/24/2024] [Indexed: 07/23/2024] Open
Abstract
Chilaiditi sign is an incidental radiological finding where the intestine is interposed between the diaphragm and liver. Chilaiditi syndrome (CS), characterized by gastrointestinal symptoms and Chilaiditi sign on imaging, is of important clinical significance despite its rarity given associated complications including intestinal obstruction, bowel ischemia, and perforation. While most cases involve the large intestine, we report a rare case of CS with ileal involvement complicated by small bowel obstruction, managed conservatively. Failure to recognize Chilaiditi sign or CS may prompt unnecessary surgical interventions, emphasizing the need for physician awareness to ensure accurate timely diagnosis and appropriate management.
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Affiliation(s)
- Bibek Saha
- Department of Internal Medicine, Mayo Clinic, Rochester, MN
| | - Anjul Verma
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN
| | | | | | - Daniel Cabrera
- Department of Emergency Medicine, Mayo Clinic, Rochester, MN
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2
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Shibasaki Y, Sohda M, Ogawa H, Katayama C, Ozawa N, Komine C, Suga K, Osone K, Okada T, Shiraishi T, Katoh R, Yokobori T, Sano A, Sakai M, Shirabe K, Saeki H. Bowel obstruction due to Chlamydia trachomatis: a case report and review of literature. Surg Case Rep 2021; 7:47. [PMID: 33590344 PMCID: PMC7883945 DOI: 10.1186/s40792-021-01130-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Accepted: 02/02/2021] [Indexed: 11/11/2022] Open
Abstract
Background Chlamydial infection is a difficult-to-diagnose type of sexually transmitted disease that occurs mainly in young people. We report a case of bowel obstruction caused by intrapelvic adhesions formed by chlamydial infection. Case presentation This patient was a 23-year-old woman who had been suffering from acute abdominal pain. She had been previously treated several times for intrapelvic abscesses and had a history of chlamydial infection. Endometriosis was thought to be the cause of her pelvic abscess based on endoscopic findings. Computed tomography demonstrated a small bowel obstruction caused by a pelvic abscess. However, the diagnosis could not be confirmed. She underwent laparoscopic surgery and was diagnosed with bowel obstruction due to adhesion of chlamydial infection based on the intraoperative findings and Chlamydia trachomatis antibody test. She was discharged 5 days after surgery. Conclusions It is necessary to consider the possibility of chlamydial infection as a cause for lower abdominal pain and unexplained bowel obstruction in female patients.
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Affiliation(s)
- Yuta Shibasaki
- Department of General Surgical Science, Division of Hepatobiliary and Pancreatic Surgery, Graduate School of Medicine, Gunma University, 3-39-22 Showa-Machi, Maebashi, Gunma, 371-8511, Japan
| | - Makoto Sohda
- Department of General Surgical Science, Division of Hepatobiliary and Pancreatic Surgery, Graduate School of Medicine, Gunma University, 3-39-22 Showa-Machi, Maebashi, Gunma, 371-8511, Japan.
| | - Hiroomi Ogawa
- Department of General Surgical Science, Division of Hepatobiliary and Pancreatic Surgery, Graduate School of Medicine, Gunma University, 3-39-22 Showa-Machi, Maebashi, Gunma, 371-8511, Japan
| | - Chika Katayama
- Department of General Surgical Science, Division of Hepatobiliary and Pancreatic Surgery, Graduate School of Medicine, Gunma University, 3-39-22 Showa-Machi, Maebashi, Gunma, 371-8511, Japan
| | - Naoya Ozawa
- Department of General Surgical Science, Division of Hepatobiliary and Pancreatic Surgery, Graduate School of Medicine, Gunma University, 3-39-22 Showa-Machi, Maebashi, Gunma, 371-8511, Japan
| | - Chika Komine
- Department of General Surgical Science, Division of Hepatobiliary and Pancreatic Surgery, Graduate School of Medicine, Gunma University, 3-39-22 Showa-Machi, Maebashi, Gunma, 371-8511, Japan
| | - Kunihiko Suga
- Department of General Surgical Science, Division of Hepatobiliary and Pancreatic Surgery, Graduate School of Medicine, Gunma University, 3-39-22 Showa-Machi, Maebashi, Gunma, 371-8511, Japan
| | - Katsuya Osone
- Department of General Surgical Science, Division of Hepatobiliary and Pancreatic Surgery, Graduate School of Medicine, Gunma University, 3-39-22 Showa-Machi, Maebashi, Gunma, 371-8511, Japan
| | - Takuhisa Okada
- Department of General Surgical Science, Division of Hepatobiliary and Pancreatic Surgery, Graduate School of Medicine, Gunma University, 3-39-22 Showa-Machi, Maebashi, Gunma, 371-8511, Japan
| | - Takuya Shiraishi
- Department of General Surgical Science, Division of Hepatobiliary and Pancreatic Surgery, Graduate School of Medicine, Gunma University, 3-39-22 Showa-Machi, Maebashi, Gunma, 371-8511, Japan
| | - Ryuji Katoh
- Department of General Surgical Science, Division of Hepatobiliary and Pancreatic Surgery, Graduate School of Medicine, Gunma University, 3-39-22 Showa-Machi, Maebashi, Gunma, 371-8511, Japan
| | - Takehiko Yokobori
- Department of General Surgical Science, Division of Hepatobiliary and Pancreatic Surgery, Graduate School of Medicine, Gunma University, 3-39-22 Showa-Machi, Maebashi, Gunma, 371-8511, Japan.,Innovative Medical Research Center, Gunma University Hospital, Graduate School of Medicine, Gunma University, 3-39-22 Showa-Machi, Maebashi, Gunma, 371-8511, Japan
| | - Akihiko Sano
- Department of General Surgical Science, Division of Hepatobiliary and Pancreatic Surgery, Graduate School of Medicine, Gunma University, 3-39-22 Showa-Machi, Maebashi, Gunma, 371-8511, Japan
| | - Makoto Sakai
- Department of General Surgical Science, Division of Hepatobiliary and Pancreatic Surgery, Graduate School of Medicine, Gunma University, 3-39-22 Showa-Machi, Maebashi, Gunma, 371-8511, Japan
| | - Ken Shirabe
- Department of General Surgical Science, Division of Hepatobiliary and Pancreatic Surgery, Graduate School of Medicine, Gunma University, 3-39-22 Showa-Machi, Maebashi, Gunma, 371-8511, Japan
| | - Hiroshi Saeki
- Department of General Surgical Science, Division of Hepatobiliary and Pancreatic Surgery, Graduate School of Medicine, Gunma University, 3-39-22 Showa-Machi, Maebashi, Gunma, 371-8511, Japan
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3
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Bonnin A, Durot C, Djelouah M, Dohan A, Arrivé L, Rousset P, Hoeffel C. MR Imaging of the Perihepatic Space. Korean J Radiol 2020; 22:547-558. [PMID: 33236541 PMCID: PMC8005346 DOI: 10.3348/kjr.2019.0774] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2019] [Revised: 05/02/2020] [Accepted: 06/23/2020] [Indexed: 11/24/2022] Open
Abstract
The perihepatic space is frequently involved in a spectrum of diseases, including intrahepatic lesions extending to the liver capsule and disease conditions involving adjacent organs extending to the perihepatic space or spreading thanks to the communication from intraperitoneal or extraperitoneal sites through the hepatic ligaments. Lesions resulting from the dissemination of peritoneal processes may also affect the perihepatic space. Here we discuss how to assess the perihepatic origin of a lesion and describe the magnetic resonance imaging (MRI) features of normal structures and fluids that may be abnormally located in the perihepatic space. We then review and illustrate the MRI findings present in cases of perihepatic infectious, tumor-related, and miscellaneous conditions. Finally, we highlight the value of MRI over computed tomography.
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Affiliation(s)
- Angèle Bonnin
- Department of Radiology, Centre Hospitalo-Universitaire de Reims, Reims, France.
| | - Carole Durot
- Department of Radiology, Centre Hospitalo-Universitaire de Reims, Reims, France
| | - Manel Djelouah
- Department of Radiology, Centre Hospitalo-Universitaire de Reims, Reims, France
| | - Anthony Dohan
- Department of Abdominal and Interventional Radiology, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris, APHP, Paris, France.,Paris Descartes University, Sorbonne Paris-Cité-Paris V, Paris, France
| | - Lionel Arrivé
- Department of Radiology, Saint-Antoine Hospital, Assistance Publique-Hôpitaux de Paris, Sorbonne Université, Paris, France
| | - Pascal Rousset
- Department of Radiology, Hospices Civils de Lyon, Centre Hospitalier Lyon Sud, Pierre Bénite, France.,Lyon 1 Claude Bernard University, Lyon, France
| | - Christine Hoeffel
- Department of Radiology, Centre Hospitalo-Universitaire de Reims, Reims, France.,CRESTIC, Reims Champagne-Ardenne University, Reims, France
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4
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Al-Ghassab RA, Tanveer S, Al-Lababidi NH, Zakaria HM, Al-Mulhim AA. Adhesive Small Bowel Obstruction due to Pelvic Inflammatory Disease: A Case Report. SAUDI JOURNAL OF MEDICINE & MEDICAL SCIENCES 2019; 6:40-42. [PMID: 30787816 PMCID: PMC6196681 DOI: 10.4103/sjmms.sjmms_10_17] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
We report a rare case of a 32-year-old woman with adhesive small bowel obstruction due to pelvic inflammatory disease. She had no history of abdominal surgery, gynecological complaints or constitutional symptoms of chronic illness. The diagnosis was based on the laparoscopic findings of small bowel adhesions, free peritoneal fluid, “violin string” adhesions of Fitz-Hugh–Curtis syndrome and left hydrosalpinx. Laparoscopic adhesiolysis was performed successfully, and the patient had an uneventful postoperative course. The authors conclude that pelvic inflammatory disease should be included as a cause of adhesive small bowel obstruction in sexually active young women with no history of abdominal surgery or constitutional symptoms of chronic disease. When performed by experienced surgeons, laparoscopy in such patients is feasible and safe.
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Affiliation(s)
- Razan A Al-Ghassab
- Department of Surgery, King Fahd Hospital of the University, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Shumaila Tanveer
- Department of Surgery, King Fahd Hospital of the University, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Noor H Al-Lababidi
- Department of Surgery, King Fahd Hospital of the University, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Hazem M Zakaria
- Department of Surgery, King Fahd Hospital of the University, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Abdulmohsen A Al-Mulhim
- Department of Surgery, King Fahd Hospital of the University, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
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5
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Yazaki T, Sato S, Tobita H, Isoda K, Miyake T, Kinoshita Y. Elderly Fitz-Hugh-Curtis syndrome observed with superb microvascular imaging system. J Med Ultrason (2001) 2018; 45:611-615. [PMID: 29464468 DOI: 10.1007/s10396-018-0865-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2017] [Accepted: 01/09/2018] [Indexed: 11/09/2022]
Abstract
Fitz-Hugh-Curtis syndrome (FHCS) is defined as inflammation on the surface of the liver following sexually transmitted chlamydia infection. We successfully observed the microvascular structure of the inflamed portion between the abdominal wall and surface of the liver in an elderly patient with FHCS using a superb microvascular imaging (SMI) system, a new technology developed for observing minute vascular flow. An 80-year-old Japanese female with right dorsal to lateral abdominal pain and fever came to our hospital. Anti-chlamydia antibodies were positive. SMI revealed signals suggesting small vessels passing from the liver surface to the hypoechoic space.
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Affiliation(s)
- Tomotaka Yazaki
- Department of Hepatology, Faculty of Medicine, Shimane University, Izumo, Japan
| | - Shuichi Sato
- Department of Hepatology, Faculty of Medicine, Shimane University, Izumo, Japan. .,Department of Gastroenterology and Hepatology, Faculty of Medicine, Shimane University, 89-1 Enya-cho, Izumo, Shimane, Japan.
| | - Hiroshi Tobita
- Department of Hepatology, Faculty of Medicine, Shimane University, Izumo, Japan
| | - Kazuki Isoda
- Department of Hepatology, Faculty of Medicine, Shimane University, Izumo, Japan
| | - Tatsuya Miyake
- Department of Hepatology, Shimane Prefectural Hospital, Izumo, Japan
| | - Yoshikazu Kinoshita
- Department of Gastroenterology, Faculty of Medicine, Shimane University, Izumo, Japan
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6
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Fiumecaldo D, Buck L. Chilaiditi’s Syndrome Causing High-Grade Small-Bowel Obstruction Requiring Exploratory Laparotomy. Mil Med 2018; 183:e281-e283. [DOI: 10.1093/milmed/usx069] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2017] [Accepted: 10/29/2017] [Indexed: 11/13/2022] Open
Affiliation(s)
- Daniel Fiumecaldo
- Department of General Surgery, Keesler Medical Center, 301 Fisher Street, Biloxi, MS 39534
| | - Lauren Buck
- Department of General Surgery, Keesler Medical Center, 301 Fisher Street, Biloxi, MS 39534
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7
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Zhang R, Tan J, Zhang G, Wang R. Chilaiditi syndrome with an unusual radiographic image: A crescent-shaped liver. Dig Liver Dis 2017; 49:452. [PMID: 28274827 DOI: 10.1016/j.dld.2017.02.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2016] [Revised: 01/31/2017] [Accepted: 02/01/2017] [Indexed: 12/11/2022]
Affiliation(s)
- Ruiguo Zhang
- Department of Nuclear Medicine, Tianjin Medical University General Hospital, Tianjin, China
| | - Jian Tan
- Department of Nuclear Medicine, Tianjin Medical University General Hospital, Tianjin, China.
| | - Guizhi Zhang
- Department of Nuclear Medicine, Tianjin Medical University General Hospital, Tianjin, China
| | - Renfei Wang
- Department of Nuclear Medicine, Tianjin Medical University General Hospital, Tianjin, China
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8
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Abstract
Fitz-Hugh-Curtis (FHC) syndrome, also known as acute perihepatitis, was discovered in 1930 and is a rare disorder characterised by inflammation of the peritoneum and the tissues surrounding the liver. This syndrome can arise as a potential complication from a pelvic inflammatory disease caused by Neisseria gonorrhoeae or Chlamydia trachomatis. This syndrome is not well known in the medical community and is often underdiagnosed. In this case report, we revisit FHC syndrome, particularly its noninvasive diagnosis and complications.
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9
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Abstract
Chilaiditi's sign and syndrome seem similar but are actually different entities, difficult to distinguish from each other. A 60-year-old female presented with a clinical scenario of intestinal obstruction, which was thought to be Chilaiditi's syndrome because of the unusual impression of gas under the diaphragm, but was confirmed as Chilaiditi's sign after laparotomy. The interposition of dilated small bowel loops below the diaphragm due to distal obstruction somewhere else can also produce a Chilaiditi's sign.
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10
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Weng WH, Liu DAR, Feng CC, Que RS. Colonic interposition between the liver and left diaphragm - management of Chilaiditi syndrome: A case report and literature review. Oncol Lett 2014; 7:1657-1660. [PMID: 24765195 PMCID: PMC3997735 DOI: 10.3892/ol.2014.1903] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2013] [Accepted: 01/30/2014] [Indexed: 12/02/2022] Open
Abstract
Chilaiditi syndrome refers to a medical condition that is indicated by the presence of Chilaiditi sign, the radiological observation of a colonic interposition between the liver and the diaphragm, and is associated with other clinical symptoms. Chilaiditi syndrome is a rare entity and therefore, is often misdiagnosed in clinical practice, however, it may be accompanied by a series of severe complications, such as bowel obstruction and perforation. The current study describes a 47-year-old male who presented with repeated abdominal pain and acute intestinal obstruction. The patient was diagnosed with Chilaiditi syndrome via radiological observation and was cured by conservative treatment. The clinical data of seven additional patients with Chilaiditi syndrome, which was reported in the Chinese literature between January 1990 and January 2013, were also collected. The pathogenesis, clinical manifestation, diagnosis and treatment of this syndrome have been reviewed and analyzed. The current study may be useful to familiarize clinical practitioners with Chilaiditi syndrome, in order to avoid a misdiagnosis during clinical treatment.
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Affiliation(s)
- Wei-Hong Weng
- Department of General Surgery, The Second Affiliated Hospital, Zhejiang University, Hangzhou, Zhejiang 310009, P.R. China
| | - DA-Ren Liu
- Department of General Surgery, The Second Affiliated Hospital, Zhejiang University, Hangzhou, Zhejiang 310009, P.R. China
| | - Cheng-Cheng Feng
- Department of Surgery, Cixi Red Cross Hospital, Cixi, Zhejiang 315300, P.R. China
| | - Ri-Sheng Que
- Department of General Surgery, The Second Affiliated Hospital, Zhejiang University, Hangzhou, Zhejiang 310009, P.R. China
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11
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Coexistence of Multiple Endocrine Neoplasia Type 2B and Chilaiditi Sign: A Case Report. Case Rep Endocrinol 2012; 2012:360328. [PMID: 23119190 PMCID: PMC3483661 DOI: 10.1155/2012/360328] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2012] [Accepted: 09/26/2012] [Indexed: 11/18/2022] Open
Abstract
We present a 15-year-old female patient with medullary thyroid carcinoma, marfanoid habitus, and mucosal ganglioneuromatosis. Our case had a RET protooncogene mutation ser836 polymorphism in exon 14 and ser904 polymorphism in exon 15. Our patient is thought to be atypical MEN2B due to the absence of M918T or A883F mutations. Chilaiditi sign is an incidental radiographic finding of a usually asymptomatic condition in which a part of intestine is located between the liver and diaphragm; however, the term “Chilaiditi syndrome” is used for symptomatic hepatodiaphragmatic interposition. The patient had no symptoms as abdominal pain, constipation, diarrhea, or emesis. Incidentally, Chilaiditi sign was diagnosed with chest radiograph and thoracoabdominal CT. Our case is the first in the literature indicating the coexistence of Chilaiditi sign and MEN2B.
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12
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Lenz M, Kindler M, Schilling M, Pollack T, Schwab W, Becker M. [Chilaiditi's syndrome complicated by subdiaphragmatic perforated appendicitis: unusual manifestation of a rare condition]. Chirurg 2012; 82:828, 830-33. [PMID: 21725673 DOI: 10.1007/s00104-011-2138-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
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.
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Affiliation(s)
- M Lenz
- Klinik für Allgemein- und Viszeralchirurgie, Weisseritztal-Kliniken GmbH, Freital, Deutschland.
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13
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Francesco FD, Sandro SD, Doria C, Ramirez C, Iaria M, Navarro V, Silvestry S, Needleman L, Frank A. Diaphragmatic Hernia Occurring 15 Months after Percutaneous Radiofrequency Ablation of a Hepatocellular Cancer. Am Surg 2008. [DOI: 10.1177/000313480807400207] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Affiliation(s)
| | | | | | | | | | - Victor Navarro
- Department of Medicine, Division of Gastroenterology and Hepatology
| | - Scott Silvestry
- Department of Surgery, Division of Cardiothoracic Surgery, and
| | - Laurence Needleman
- Department of Radiology, Jefferson Medical College, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
| | - Adam Frank
- Department of Surgery, Division of Transplantation
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