Chilaiditi syndrome
Updates to Article Attributes
Chilaiditi syndrome is one of the causes of pseudopneumoperitoneum and occurs when bowel gas is interposed between the liver and the hemidiaphragm resulting in pain. Gas in this position may be misinterpreted as true pneumoperitoneum resulting in further imaging, investigation and treatment that is not required.
Pain distinguishes Chilaiditi syndrome from colonic interposition.
Radiographic features
Plain radiograph
Features that suggest a Chilaiditi syndrome (termed the Chilaiditi sign) include:
- gas between liver and diaphragm
- rugal folds within the gas suggesting that it is within the bowel and not free
CT
If there is a clinical suspicion of abdominal visceral perforation and plain radiographic appearances are not clear then patients can go on to have abdominal CT to clarify whether or not there is pneumoperitoneum.
CT can clearly demonstrated the presence of interposed colonic loops between the right hemidiaphragm and liver with no free intraperitoneal air.
History and etymology
It is named after Dr Demetrius Chilaiditi (1883),Greek radiologist who described the radiographic findings in 1910 3; Vienna, Austria.
Treatment
Asymptomatic patient's with Chiladiti's sign do not require any specific treatment. Those with abdominal pain or distension or usually treated conservatively with analgesia and fluid resuscitation. Patient with recurrent presentations or evidence of bowel ischaemia may be offered surgical treatment. Gangrenous or ischaemic bowel segments may have to be removed if there is associated colonic volvulus. Otherwise, cecopexy may be sufficient to prevent future recurrence of symptoms.
-</ul><h4>History and etymology</h4><p>It is named after <strong>Dr Demetrius </strong><strong>Chilaiditi </strong>(1883),<strong> </strong>Greek radiologist who described the radiographic findings in 1910 <sup>3</sup>; Vienna, Austria.</p>- +</ul><h5>CT</h5><p>If there is a clinical suspicion of abdominal visceral perforation and plain radiographic appearances are not clear then patients can go on to have abdominal CT to clarify whether or not there is pneumoperitoneum.</p><p>CT can clearly demonstrated the presence of interposed colonic loops between the right hemidiaphragm and liver with no free intraperitoneal air. </p><h4>History and etymology</h4><p>It is named after <strong>Dr Demetrius </strong><strong>Chilaiditi </strong>(1883),<strong> </strong>Greek radiologist who described the radiographic findings in 1910 <sup>3</sup>; Vienna, Austria.</p><h4>Treatment</h4><p>Asymptomatic patient's with Chiladiti's sign do not require any specific treatment. Those with abdominal pain or distension or usually treated conservatively with analgesia and fluid resuscitation. Patient with recurrent presentations or evidence of bowel ischaemia may be offered surgical treatment. Gangrenous or ischaemic bowel segments may have to be removed if there is associated colonic volvulus. Otherwise, cecopexy may be sufficient to prevent future recurrence of symptoms.</p>
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