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      An Overlooked Case of Abdominal Pain and Bowel Dysfunction: Chilaiditi Syndrome

      case-report

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          Abstract

          Chilaiditi syndrome is an uncommon and often misdiagnosed condition characterized by the interposition of the colon between the liver and diaphragm, leading to symptoms of abdominal pain, bloating, and bowel dysfunction. Risk factors include chronic constipation, anatomical variations, and diaphragmatic dysfunction. This report presents the case of a 67-year-old male with right upper quadrant discomfort exacerbated by stool retention. Imaging studies ruled out acute pathology for critical conditions but demonstrated colonic interposition suggestive of Chilaiditi syndrome. Management provided consisted of conservative measures including dietary modifications and fiber supplementation, alleviating his symptoms without necessitating invasive procedures. This report emphasizes the importance of recognizing radiographic findings and risk factors of Chilaiditi syndrome in patients with nonspecific gastrointestinal complaints to avoid unnecessary medical interventions.

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          Chilaiditi syndrome precipitated by colonoscopy: a case report and review of the literature.

          Chilaiditi syndrome is a rare condition defined by the presence of gastrointestinal symptoms associated with the radiological finding of segmental interposition of the bowel between the liver and the diaphragm. While it is infrequently indentified as a source of abdominal pain, Chilaiditi syndrome carries clinical significance as it can lead to a number of serious complications including intestinal obstruction, perforation, and ischemia. A 58-year-old woman presented with Chilaiditi syndrome immediately following colonoscopic evaluation. Conservative measures failed to alleviate the patient's symptoms, and the patient ultimately elected to have operative management. Pexy of the cecum and ascending colon led to full resolution of her symptoms. To our knowledge, this is the first documented case of Chilaiditi syndrome iatrogenically induced by colonoscopy. Identification of this syndrome as a complication of colonoscopy and a source of post-procedural pain bears significance for providers involved in the peri-operative care of patients with factors predisposing them to the development of this condition.
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            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.
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              Colonic Interposition between the Liver and Diaphragm: “The Chilaiditi Sign”

              A 90-year-old wheelchair bound male was brought to the emergency department with complaints of worsening abdominal pain over the last 2-3 days. The patient also had difficulty in passing urine. Abdominal examination revealed tenderness in the umbilical and hypogastric area without rebound tenderness or guarding. Computed tomography (CT) of the abdomen showed a loop of colon interpositioned between the liver and the right hemidiaphragm (the Chilaiditi sign), mimicking free air. Foley's catheter was placed and the patient was managed conservatively. The patient clinically improved with improvement of the abdominal pain.

                Author and article information

                Journal
                Cureus
                Cureus
                2168-8184
                Cureus
                Cureus (Palo Alto (CA) )
                2168-8184
                3 April 2025
                April 2025
                : 17
                : 4
                : e81638
                Affiliations
                [1 ] School of Medicine, Lake Erie College of Osteopathic Medicine, Bradenton, USA
                [2 ] Gastroenterology, Borland Groover, Jacksonville, USA
                Author notes
                Article
                10.7759/cureus.81638
                12048822
                40322394
                ad36c084-71b0-4893-8a81-c6c39337fb3f
                Copyright © 2025, Adili et al.

                This is an open access article distributed under the terms of the Creative Commons Attribution License CC-BY 4.0., which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

                History
                : 3 April 2025
                Categories
                Radiology
                Gastroenterology
                Geriatrics

                chilaiditi sign,chilaiditi’s syndrome,colonic interposition,gastroenterology medicine,general radiology

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