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The Chilaiditi's Sign

Distended bowel, usually hepatic flexure of the colon, interposed between the liver and the diaphragm:
The Chilaiditi Sign or Hepatodiaphragmatic Interposition of the Intestine.
Chilaiditi’s Syndrome is important because it can simulate pneumoperitoneum ( so also called pseudo-pneumo-peritoneum ) .
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A rare disorder where a part of the colon, or sometimes intestine, is abnormally positioned between the liver and the diaphragm. The defect may occur in people who have chronic lung disease or abdominal ascites but may also occur in healthy individuals without causing symptoms.
The list of signs and symptoms mentioned in various sources for Chilaiditi syndrome includes the 8 symptoms listed below:
Asymptomatic , Abdominal pain , Vomiting , Anorexia , Constipation , Flatulence , Air swallowing and Feeling of pressure in upper abdomen when upright.
Radiographic features:
Plain film:
Features that suggest a Chilaiditisyndrome (termed the Chilaiditi sign) include:
gas between liver and diaphragm
rugal folds within the gas suggesting that it is within bowel and not free.
Etymology:
Named after Dr Demetrius Chiladaiti : Greek radiologist who described the radiographic findings in 1910 .
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References:
1. Lekkas CN, Lentino W. Symptom producing interposition of the colon: clinical syndrome in mentally deficient adults. JAMA 1978;240:747-50.
2. Vessal K, Borhanmanesh F. Hepatodiaphragmatic interposition of the intestine (Chilaiditi's syndrome). Clin Radiol1976;27:113-6.
3. Chilaiditi D. Zur Frage der Hepatoptose und Ptose im allgemeinen im Anschluss an drei Falle von temporarer, partieller Leberverlagerung. Fortschr Geb Rontgenstr Nuklearmed Erganzungsband1910; 16:173 -208
4. Robert D. Glatter, MD,Severe Recurrent Abdominal Pain: An Anatomical Variant of Chilaiditi's Syndrome, MedGenMed. 2007; 9(2): 67. Published online 2007 June 27.
5. D. F. Altomare,Chilaiditi's syndrome. Successful surgical correction by colopexy. Techniques in Coloproctology Volume 5, Number 3, 173-175, DOI: 10.1007/s101510100022

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Comment by OBOKE OZOEMENA S. on July 17, 2011 at 3:52pm

It is a normal variant

Comment by saeed rad on July 6, 2011 at 12:41pm
Volvulus of the transverse colon results from the elongation of the transverse mesocolon,but this one is the interposition of the hepatic flexure of it, and i think there is no relation. I have seen transverse colon volvulus which i am going to post now for you.
Comment by herbert kaufman on July 6, 2011 at 11:16am

Althought I have never seen a case, I understand that volvulus of transverse colon can be associated with the finding.

 

kaufmanherb

Comment by nermeenmohammed on July 3, 2011 at 3:16pm
thanks
Comment by saeed rad on April 28, 2011 at 12:52pm
Thanx once more.
Comment by M.T Niknejad on April 28, 2011 at 6:03am
Thanks ...
Comment by saeed rad on April 14, 2011 at 11:35am
Although i don't like the intervention but the question of Dr Zakaria Elzoghbi was sent to me too, and i had to answer his question. Hope you don't mind the comment. He is a specialist of chest and needed to be convinced. Hope this is what he wanted to know, if not i will post further x-rays for him even Chilaiditi created by dolichosigmoid! not only right flexure of colon. Thanks again for the educational demonstration.
Comment by saeed rad on April 13, 2011 at 1:50pm
It can be confused with pneumoperitoneum when it is just a parcel of colon without showing haustra. Lateral chest will show it in front and above the liver, or it may change the configuration in supine films of abdomen.
Comment by Zakaria Elzoghbi on April 13, 2011 at 1:20pm

nice case ,but i ask about the management?

Comment by saeed rad on April 12, 2011 at 12:39pm
Cool case with anatomic demonstration. Thank you.

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