Chilaiditi syndrome: Difference between revisions

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{{Infobox medical condition (new)
{{Short description|A rare condition involving the interposition of the colon between the liver and diaphragm}}
| name            = Chilaiditi syndrome
| synonyms        = Chilaiditi's sign
| image          = Chilaiditi obvious.jpg
| caption        = [[Chest X-ray]] showing obvious Chilaiditi's sign, or presence of gas in the right colic angle between the liver and right hemidiaphragm.
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| field          = [[General surgery]]
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}}
[[Image:Chilaiditi 1.PNG|thumb|Chest X-ray of the same patient as the picture above. A small crescent of air can be seen under the right part of the diaphragm, caused by Chilaiditi's sign. However, it could easily be mistaken for free intra-abdominal air ([[pneumoperitoneum]]) which could mistakenly be attributed to bowel perforation.]]
'''Chilaiditi syndrome''' is a rare condition when pain occurs due to transposition of a loop of [[colon (anatomy)|large intestine]] (usually [[transverse colon]]) in between the [[diaphragm (anatomy)|diaphragm]] and the [[liver]], visible on plain [[abdominal X-ray]] or [[chest X-ray]].<ref name="pmid15869145">{{cite journal |vauthors=Saber AA, Boros MJ |title=Chilaiditi's syndrome: what should every surgeon know? |journal=Am Surg |volume=71 |issue=3 |pages=261–3 |date=March 2005 |pmid=15869145 |doi= |url=}}</ref>


Normally this causes no symptoms, and this is called Chilaiditi's sign. The sign can be permanently present, or sporadically. This [[anatomical variant]] is sometimes mistaken for the more serious condition of having air under the diaphragm ([[pneumoperitoneum]]) which is usually an indication of [[bowel perforation]], possibly leading to surgical interventions.
'''Chilaiditi syndrome''' is a rare medical condition characterized by the interposition of the [[colon]] between the [[liver]] and the [[diaphragm]]. This anatomical anomaly can lead to various clinical symptoms, although it is often discovered incidentally on [[radiographic imaging]].


Chilaiditi syndrome refers only to complications in the presence of Chilaiditi's sign. These include [[abdominal pain]],<ref name="pmid17955121">{{cite journal |vauthors=Glatter RD, April RS, Miskovitz P, Neistadt LD |title=Severe Recurrent Abdominal Pain: An Anatomical Variant of Chilaiditi's Syndrome |journal=MedGenMed |volume=9 |issue=2 |pages=67 |year=2007 |pmid=17955121 |pmc=1994890 |doi= |url=}}</ref> torsion of the bowel (transverse colon [[volvulus]])<ref name="pmid8946999">{{cite journal |vauthors=Plorde JJ, Raker EJ |title=Transverse colon volvulus and associated Chilaiditi's syndrome: case report and literature review |journal=Am. J. Gastroenterol. |volume=91 |issue=12 |pages=2613–6 |date=December 1996 |pmid=8946999 |doi= |url=}}</ref> or [[shortness of breath]].<ref name="pmid16489467">{{cite journal |vauthors=Keles S, Artac H, Reisli I, Alp H, Koc O |title=Chilaiditi syndrome as a cause of respiratory distress |journal=Eur. J. Pediatr. |volume=165 |issue=6 |pages=367–9 |date=June 2006 |pmid=16489467 |doi=10.1007/s00431-005-0077-9}}</ref>
==History==
Chilaiditi syndrome is named after the Greek radiologist [[Demetrius Chilaiditi]], who first described the condition in 1910. The term "Chilaiditi sign" refers to the radiological finding of colonic interposition without associated symptoms, whereas "Chilaiditi syndrome" is used when the condition is symptomatic.
 
==Pathophysiology==
The exact cause of Chilaiditi syndrome is not well understood, but it is believed to result from a combination of anatomical and physiological factors. These may include:
 
* A congenitally elongated or redundant colon
* Laxity or absence of the suspensory ligaments of the liver
* A small liver size or [[hepatoptosis]]
* Increased intra-abdominal pressure
 
==Clinical Presentation==
Patients with Chilaiditi syndrome may present with a variety of symptoms, including:


==Causes==
* Abdominal pain
The exact cause is not always known, but it may occur in patients with a long and mobile colon ([[dolichocolon]]), chronic lung disease such as [[emphysema]], or liver problems such as [[cirrhosis]] and [[ascites]]. Chilaiditi's sign is generally not associated with symptoms, and is most commonly an incidental finding in normal individuals.
* Nausea and vomiting
* Constipation or [[obstipation]]
* Respiratory distress due to diaphragmatic elevation


Absence or laxity of the ligament suspending the transverse colon or of the [[falciform ligament]] are also thought to contribute to the condition. It can also be associated with relative atrophy of the medial segment of the left lobe of the liver. In this case, the gallbladder position is often anomalous as well – it is often located anterior to the liver, rather than posterior.
In some cases, the condition may mimic other acute abdominal conditions, such as [[bowel obstruction]] or [[pneumoperitoneum]].


==Epidemiology==
==Diagnosis==
The occurrence ([[Incidence (epidemiology)|incidence]]) on abdominal or chest X-rays is around 0.1% but it can be up to 1% in series of [[geriatrics|older adults]].<ref name="pmid842405">{{cite journal |vauthors=Walsh SD, Cruikshank JG |title=Chilaiditi syndrome |journal=Age Ageing |volume=6 |issue=1 |pages=51–7 |date=February 1977 |pmid=842405 |doi= 10.1093/ageing/6.1.51|url=http://ageing.oxfordjournals.org/cgi/pmidlookup?view=long&pmid=842405}}</ref> It has also been reported in children.<ref name="pmid16489467" />
The diagnosis of Chilaiditi syndrome is primarily made through imaging studies. A plain [[abdominal X-ray]] may reveal the characteristic interposition of the colon between the liver and diaphragm. [[Computed tomography]] (CT) scans can provide more detailed information and help differentiate Chilaiditi syndrome from other conditions.


==History==
==Management==
Chilaiditi's sign is named after the Greek radiologist Dimítrios Chilaiditi, born in 1883, who first described it when he was working in Vienna in 1910.<ref>D. Chilaiditi: {{lang|de|Zur Frage der Hepatoptose und Ptose im allgemeinen im Anschluss an drei Fälle von temporärer, partieller Leberverlagerung. ''Fortschritte auf dem Gebiete der Röntgenstrahlen''|italic=unset}}, 1910, 16: 173-208.</ref><ref name=WhoNamedIt>{{WhoNamedIt|synd|2326}}</ref>
Treatment of Chilaiditi syndrome depends on the severity of symptoms. In asymptomatic cases, no treatment is necessary. For symptomatic patients, conservative management is usually the first line of treatment and may include:
 
* Bowel rest
* Nasogastric decompression
* Laxatives or enemas to relieve constipation


==Synonyms==
Surgical intervention is rarely required but may be considered in cases of persistent symptoms or complications such as bowel obstruction or ischemia.
Synonyms include interpositio hepatodiaphragmatica, subphrenic displacement of the colon, subphrenic interposition syndrome and pseudopneumoperitoneum.


==References==
==Prognosis==
{{reflist}}
The prognosis for individuals with Chilaiditi syndrome is generally good, especially when the condition is managed conservatively. Most patients experience relief of symptoms with appropriate treatment.
http://www.jmedsoc.org/text.asp?2018/32/3/222/252005.


== External links ==
==Related pages==
{{Medical resources
* [[Hepatodiaphragmatic interposition]]
| DiseasesDB    = 32496
* [[Bowel obstruction]]
| ICD10          =
* [[Pneumoperitoneum]]
| ICD9          =
| ICDO          =
| OMIM          =
| MedlinePlus    =
| eMedicineSubj  =
| eMedicineTopic =
| MeshID        = D059269
}}
{{Digestive system diseases}}
{{Eponymous medical signs for digestive system and general abdominal signs}}


[[Category:Syndromes affecting the gastrointestinal tract]]
[[Category:Gastroenterology]]
{{dictionary-stub1}}
[[Category:Rare diseases]]
[[Category:Syndromes]]

Revision as of 19:25, 22 March 2025

A rare condition involving the interposition of the colon between the liver and diaphragm


Chilaiditi syndrome is a rare medical condition characterized by the interposition of the colon between the liver and the diaphragm. This anatomical anomaly can lead to various clinical symptoms, although it is often discovered incidentally on radiographic imaging.

History

Chilaiditi syndrome is named after the Greek radiologist Demetrius Chilaiditi, who first described the condition in 1910. The term "Chilaiditi sign" refers to the radiological finding of colonic interposition without associated symptoms, whereas "Chilaiditi syndrome" is used when the condition is symptomatic.

Pathophysiology

The exact cause of Chilaiditi syndrome is not well understood, but it is believed to result from a combination of anatomical and physiological factors. These may include:

  • A congenitally elongated or redundant colon
  • Laxity or absence of the suspensory ligaments of the liver
  • A small liver size or hepatoptosis
  • Increased intra-abdominal pressure

Clinical Presentation

Patients with Chilaiditi syndrome may present with a variety of symptoms, including:

  • Abdominal pain
  • Nausea and vomiting
  • Constipation or obstipation
  • Respiratory distress due to diaphragmatic elevation

In some cases, the condition may mimic other acute abdominal conditions, such as bowel obstruction or pneumoperitoneum.

Diagnosis

The diagnosis of Chilaiditi syndrome is primarily made through imaging studies. A plain abdominal X-ray may reveal the characteristic interposition of the colon between the liver and diaphragm. Computed tomography (CT) scans can provide more detailed information and help differentiate Chilaiditi syndrome from other conditions.

Management

Treatment of Chilaiditi syndrome depends on the severity of symptoms. In asymptomatic cases, no treatment is necessary. For symptomatic patients, conservative management is usually the first line of treatment and may include:

  • Bowel rest
  • Nasogastric decompression
  • Laxatives or enemas to relieve constipation

Surgical intervention is rarely required but may be considered in cases of persistent symptoms or complications such as bowel obstruction or ischemia.

Prognosis

The prognosis for individuals with Chilaiditi syndrome is generally good, especially when the condition is managed conservatively. Most patients experience relief of symptoms with appropriate treatment.

Related pages

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