Misdiagnosis of air under diaphragm: a case report

Abstract

Introduction: Air under the right hemidiaphragm in an erect plain chest radiograph from interposition of bowel is known as Chilaiditi’s sign; when symptomatic becomes a syndrome. Right subphrenic ileal entrapment with obstructive symptoms is rare. Preoperatively, this can be misdiagnosed as pneumoperitoneum usually from perforation of a hollow viscus.
Aim: To report a rare clinical condition with radiological feature of air under the diaphragm and increase awareness of this condition in our environment.
Case Report: A 61yr old woman presented with colicky, generalised  abdominal pains, vomiting of recently ingested feed, progressive abdominal distention and constipation suggestive of intestinal obstruction. An erect chest radiograph showed gas under the right diaphragm. Exploratory laparotomy after resuscitation revealed a right subphrenic ileal entrapment with non viable areas of constriction. A resection and ileo-ileal anastomosis was done. Post-operative period was uneventful.
Conclusion: The radiological feature of air under the diaphragm with clinical evidence of mechanical bowel obstruction known as Chilaiditi’s syndrome is not always from right hemi-hepatodiaphragmatic colonic interposition. Ileal entrapment with a featureless gas pattern is hereby reported.

Keywords: Chilaiditi syndrome, intestinal obstruction, ileal entrapment