![]() ![]() Physiologic and conformational patterns of hepatic and colonic embryogenesis and adult anatomy usually prevent the development of colonic interposition. 3 The bowel segments most commonly found interposed between the liver and diaphragm or abdominal wall are the colonic hepatic flexure and transverse colon, although interposition of the small bowel has also been reported. The prevalence of Chilaiditi sign in the general population is 0.025–0.28%, and the sign is more prevalent in male patients than female patients. This sign is commonly misinterpreted as pneumoperitoneum. A Chilaiditi sign is thus used to describe the incidental radiologic finding of a colonic or intestinal hepatodiaphragmatic interposition in an asymptomatic patient. In 1910, the radiologist Demetrius Chilaiditi described 3 patients who had an interposition of the bowel between the liver and right hemidiaphragm. The colon did not have any abnormalities. The bowel initially appeared to be mildly ischemic, but it regained viability after the closed loop was untwisted and warm saline was applied hence, resection was not necessary. A 6–8-inch segment of the terminal ileum that was approximately 3 feet from the ileocecal valve was involved in a closed-loop obstruction above the liver secondary to adhesions between the liver and the abdominal wall. On the basis of the patient’s presentation and imaging results, the patient was taken to the operating room for an exploratory laparotomy. The CT scans also demonstrated mild small bowel wall thickening with inflammatory changes, air-fluid levels, and an abrupt transition in bowel caliber that was characteristic of small bowel obstruction (Figure 1). The patient’s gallbladder had normal dimensions and wall thickness, and there was no evidence of cholelithiasis.Ĭomputed tomography (CT) scans of the abdomen and pelvis performed with intravenous and oral contrast demonstrated an abnormal course and configuration of the small bowel and colon, with portions of the transverse colon traveling through the Morrison pouch multiple small bowel loops were also seen interposed among the liver, abdominal wall, and diaphragm. A right upper quadrant ultrasound demonstrated irregular shadowing in the liver, with a morphology similar to that of the small bowel. Results of the patient’s complete blood count, liver function tests, and urinalysis were normal. Her abdomen was distended with decreased bowel sounds, tenderness in the right upper quadrant, and a positive Murphy sign with rebound tenderness. On physical examination, she was hemodynamically stable. Her surgical history was significant for a Cesarean section, ovarian cystectomy, and appendectomy. The patient reported having vomiting episodes during her childhood. Her pain was associated with nausea, constipation, and obstipation, as well as nonbilious and nonbloody emesis on several occasions. 2Ī 55-year-old African-American woman presented to the emergency department with a history of gradually increasing abdominal pain localized to the epigastrium and right upper quadrant that radiated to the right shoulder. 1 Most patients with this intestinal anomaly are asymptomatic throughout their lives however, they can manifest with intermittent abdominal pain, distention, vomiting, anorexia, and constipation that on rare occasions require surgical intervention. Demetrius Chilaiditi described the first cases of this disease in 1910. Wellington Avenue, Room 4807, Chicago, IL 60657 Tel: 77 E-mail: syndrome is a rare disease in which intestinal obstruction is caused by hepatodiaphragmatic interposition of the colon or small bowel. Mateo de Acosta Andino, Department of Surgery, Metropolitan Group Hospitals, University of Illinois, 836 W. Chilaiditi Syndrome Complicated by a Closed-Loop Small Bowel ObstructionġDepartment of Surgery,Metropolitan Group Hospitals, University of Illinois, Chicago, Illinois 2Department of Surgery,Mercy Hospital and Medical Center, Metropolitan Group Hospitals, University of Illinois, Chicago, IllinoisĪddress correspondence to: Dr.
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