Laparoscopic management of Chilaiditi?s syndrome

Congenital partial diaphragmatic eventration presenting with Chilaiditi's sign: a case report

BACKGROUND

Chilaiditi's sign is an incidental radiographic finding, associated with intestinal disposition located between liver and right diaphragm. It is considered as an acquired rather than a congenital condition and the prevalence ranges from 1.18% to 2.4% according to recent adult retrospective studies. The aspects of this rare entity with regards to a 7-month-old male initially misdiagnosed as diaphragmatic hernia is discussed.

CASE PRESENTATION

A 4-month-old Caucasian male was misdiagnosed with a congenital diaphragmatic hernia owing to previous hospitalization with complaints of respiratory tract infection. On admission 3 months later, he was free of any signs and symptoms of intestinal obstruction or respiratory distress. Thorax computed tomography revealed Chilaiditi's sign. A diagnostic laparoscopy was regarded necessary to evaluate the anatomical details. The most prominent finding was the lack of muscle fibers and almost transparent appearance of the medial aspect of the partially eventrated right hemidiaphragm. Owing to delicate anatomical presentation, diaphragmatic plication was considered hazardous. The patient is doing well and under follow-up.

CONCLUSIONS

It is obvious that Chilaiditi's sign is not always a completely incidental finding of no consequence, and may indicate an underlying congenital diaphragmatic pathology, clearly defined by laparoscopic evaluation in this case.

Chilaiditi Sign and Syndrome: A Rare Case Seen After Open-Heart Surgery

Chilaiditi sign is a rare radiologic finding usually diagnosed incidentally. If it presents with symptoms such as nausea, vomiting, abdominal discomfort, and abdominal pain, it is called Chilaiditi syndrome. Here, we present an 81-year-old male patient who demonstrated Chilaiditi syndrome and signs after open-heart surgery.

Death Caused by Hepatodiaphragmatic Interposition of the Colon

Hepatodiaphragmatic interposition of the colon is a rare, usually asymptomatic, anomaly and is typically an incidental radiologic finding. There are few cases in the literature describing the symptomatic form of the condition, known as Chilaiditi syndrome. In some cases, it may be accompanied by various severe complications. If symptoms are present, usually conservative treatment is given. However, conservative treatment only addresses the symptoms but does not prevent their recurrence and possible complications. Our present report shows that this anomaly may not only cause symptoms, but may also progress and cause severe complications, in our case-megacolon leading to right heart failure and, ultimately, death. To date, however, there have been no literature reports of death caused by colonic interposition. Therefore, it is important to draw attention to the importance of this anomaly and its appropriate diagnosis and treatment to ensure the most favorable patient outcomes.

Colonic interposition between the liver and left diaphragm - management of Chilaiditi syndrome: A case report and literature review

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.

Minimally invasive colopexy for pediatric Chilaiditi syndrome

Chilaiditi syndrome is a rare disorder characterized by abdominal pain, respiratory distress, constipation, and vomiting in association with Chilaiditi's sign. Chilaiditi's sign is the finding on plain roentgenogram of colonic interposition between the liver and diaphragm and is usually asymptomatic. Surgery is typically reserved for cases of catastrophic colonic volvulus or perforation because of the syndrome. We present a case of a 6-year-old boy who presented with Chilaiditi syndrome and resulting failure to thrive because of severe abdominal pain and vomiting, which did not improve with laxatives and dietary changes. He underwent a laparoscopic gastrostomy tube placement and laparoscopic colopexy of the transverse colon to the falciform ligament and anterior abdominal wall. Postoperatively, his symptoms resolved completely, as did his failure to thrive. His gastrostomy tube was removed 3 months after surgery and never required use. This is the first case of Chilaiditi syndrome in the pediatric literature we are aware of that was treated with an elective, minimally invasive colopexy. In cases of severe Chilaiditi syndrome refractory to medical treatment, a minimally invasive colopexy should be considered as a possible treatment option and potentially offered before development of life-threatening complications such as volvulus or perforation.

Chilaiditi's sign mimicking a traumatic diaphragmatic hernia

A 75-year-old man had bruising develop after a traffic accident. A chest roentgenogram revealed elevation of the right hemidiaphragm. A subsequent computed tomographic scan showed interposition of the colon between the liver and diaphragm in front of the liver. Initially, we suspected a traumatic diaphragmatic hernia. Urgent exploratory video-assisted thoracoscopic surgery showed no injury of the right diaphragm. With the benefit of hindsight, there was no rupture of the diaphragm on the image. Hepato-diaphragmatic interposition of the colon is a very rare anomaly. This case was "Chilaiditi's sign" mimicking a traumatic diaphragmatic hernia.