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A rare condition in which a portion of the colon is abnormally (interposed) between the liver and the diaphragm.
This anomaly was first described in the medical literature in 1910 by a Greek radiologist named Demetrius Chilaiditi.
Chilaiditi syndrome can cause various symptoms, including abdominal pain, nausea, vomiting, and small bowel obstruction.
In most cases, interposing a portion of the colon between the liver and the diaphragm causes no symptoms and is often an incidental finding in the elderly. When there are no symptoms, this clinical finding is known as the Chilaiditi sign.
The diaphragm is the muscle that separates the thoracic cavity from the abdomen.
The causes of Chilaiditi syndrome are not entirely understood.
In rare cases, the symptoms develop; These cases are known as Chilaiditi syndrome.
Signs and symptoms
The symptoms of Chilaiditi syndrome can vary from one person to another. The presentation and the specific symptoms that develop can be significantly different.
Chronic and recurrent episodes of abdominal pain are common findings. Abdominal pain may be mild and come and go (intermittent). However, abdominal pain can be severe and force affected people to go to the emergency room.
Other symptoms may occur together in a wide variety of different combinations. Affected people will not have all these symptoms, and some involved people will not have any of these symptoms.
Nausea, vomiting, constipation, indigestion ( dyspepsia ), abnormal twisting of the bowels (volvulus) causing obstruction, abdominal swelling (distension), difficulty swallowing ( dysphagia ), and sensitivity in the upper part have been reported—the central area of the abdomen (epigastric region).
In some cases, Chilaiditi syndrome has been associated with respiratory problems (respiratory distress).
Causes
The exact cause of Chilaiditi syndrome is unknown. The condition occurs more frequently in individuals with chronic lung disease, scarring of the liver ( cirrhosis ), and fluid accumulation within the abdominal cavity ( ascites ). Ascites can be associated with a wide variety of medical conditions.
Additional predisposing factors include abnormal elongation of the colon or abnormal looseness (laxity) of specific ligaments of the colon and liver. Ligaments are fibrous and resistant tissue bands that serve mainly to connect or support structures within the body.
According to the medical literature, other factors may play a role in developing Chilaiditi syndromes in some cases, such as reduced liver volume and paralysis of the motor nerve of the diaphragm (phrenic nerve paralysis), and obesity.
Populations affected
The Chilaiditi syndrome affects men and women in equal numbers. It is more common in older adults, but it can occur at any age and is reported in children. The incidence of Chilaiditi syndrome is unknown. A published report estimated the incidence in 25% and 28% of the general population.
Related disorders
Some disorders may have symptoms similar to those of Chilaiditi syndrome:
Chilaiditi syndrome can be confused with pneumoperitoneum, which can cause unnecessary surgery.
Pneumoperitoneum is the abnormal presence of gas or air within the abdominal cavity. It can have a variety of different causes. The specific symptoms that occur depend on the grounds.
Diagnosis
The diagnosis of Chilaiditi syndrome is based on the confirmation (radiographic) of the abnormal position of the colon and the appearance of associated symptoms. Such imaging techniques may include chest and abdominal radiographs, ultrasound, or computed tomography (CT).
Treatment
The treatment of Chilaiditi syndrome addresses the specific symptoms evident in each individual. Some affected people may not require any therapy.
The elimination of the pressure on the intestines (decompression of the cup) has alleviated the symptoms in some cases. In some cases, surgical intervention may be required.
