Chilaiditi Syndrome

A 46-year-old man presented with a 2-day history of abdominal pain, nausea and vomiting. The abdomen was diffusely tender, and the bowel sounds were sluggish. Chest/ abdominal radiographs (Picture 1, 2) and abdominal/pelvic computed tomography (CT) were performed (Picture 3). Chilaiditi syndrome is the interposition of the right colon between the liver and right hemi-diaphragm; the bowels containing air can be seen interposed between the liver and diaphragm on X-ray, helping to distinguish it from pneumoperitoneum. The presence of haustra in the hepatodiaphragmatic space aids in the distinction between intraluminal gas and free air. Abdominal/pelvic CT showing the bowel between the liver and diaphragm confirms the diagnosis. Chilaiditi syndrome was first described in 1910 by Chilaiditi, a Greek radiologist (1). The incidence of this syndrome in the general population ranges from 0.025% to 0.28% (2). Unless the presence of volvulus is suspected, patients with Chilaiditi syndrome often respond to conservative treatments, such as nasogastric decompression.