Chilaiditi's syndrome as an acute abdomen

Abstract

Background: Hepato-diaphragmatic interposition of the intestine is uncommon. Although known as  Chilaiditi syndrome, the diagnosis is often missed. As more cases are seen, it has been shown that the disease condition is a potential cause of acute abdomen requiring emergency or elective operation.
Aim: To report a case of Chilaiditi syndrome that masqueraded as an acute abdomen with an epigastric mass.
Case Report: A 44-year-old man presented with a 4-week history of severe abdominal pain and fullness, excessive belching and occasional haematemesis.  He was initially being managed for peptic ulcer disease. There was no response and was therefore referred to the University of Port Harcourt Teaching Hospital for further evaluation and treatment.
Clinical examination in the hospital revealed an ill-defined mass to the right of the epigastrium, firm to touch and not tender. A diagnosis of carcinoma of the stomach with a differential diagnosis of a primary hepato-cellular carcinoma was entertained. Haematological investigations showed a low haemoglobin    of 7.4gm/dl. The white cell  differentials were within normal values. The liver function tests as well as the urea and electrolytes were also within normal range. The abdominal radiograph was normal but the abnormality on the chest radiograph was missed. The CT scan showed the typical hepato-diaphragmatic interposition of the intestine and the diagnosis was made. The interposed loop of bowel reduced spontaneously following conservative management.
Conclusion: As Chilaiditi syndrome is a rare disease entity, a high index of suspicion is required to make an accurate diagnosis. It should be considered as one of the differential diagnoses of an acute abdomen.

Keywords: Acute abdomen, Chilaiditi syndrome,  Radiographic diagnosis