Bodega Quiroga I, Tejedor Togores P, Peraza Casajús J M, Villadóniga A, Sánchez-Seco Peña M I, Serrano Muñoz A
Department of General and Gastrointestinal Surgery, Hospital Central de la Defensa "Gómez Ulla", Glorieta del Ejército s/n, Madrid, Spain.
Indian J Surg. 2015 Dec;77(Suppl 2):742-3. doi: 10.1007/s12262-013-0914-4. Epub 2013 Apr 16.
Chilaiditi syndrome is a strange disease which includes the existence of Chilaiditi sign and other abdominal symptoms. Chilaiditi sign refers the interposition of the colon between the liver and diaphragm that could be misinterpreted to be a pneumoperitoneum. We present a 46-year-old male patient who was admitted in the hospital with constipation and abdominal oppressive pain located in the epigastric area. He showed signs of peritoneal irritation, no bowel sounds, hernias, or organ enlargements. Laboratory analysis only revealed CPK elevation (462 U/L). Abdominal and chest radiographs showed an image which suggested a pneumoperitoneum. The patient underwent emergency surgical treatment, under diagnosis of viscera perforation. At laparotomy, an interposition of the transverse colon between the liver and diaphragm were visualized, although no perforations were present. Psychiatric treatment was held until this moment due to the high risk of schizophrenia outbreak. During the next 48 h, intestinal transit was restored and he was discharged on postoperative day 40, diagnosed with Ogilvie syndrome secondary to psychotropics. The relationship between Ogilvie syndrome and psychiatric treatments is known, but the association between Ogilvie and Chilaiditi syndrome is very strange. Nevertheless, it could be misinterpreted like a pneumoperitoneum and led to the performance of emergency surgery.
奇莱迪蒂综合征是一种罕见疾病，包括奇莱迪蒂征的存在及其他腹部症状。奇莱迪蒂征是指结肠位于肝脏和膈肌之间，可能被误诊为气腹。我们报告一名46岁男性患者，因便秘和上腹部压迫性疼痛入院。他有腹膜刺激征，无肠鸣音、疝气或器官肿大。实验室检查仅显示肌酸磷酸激酶升高（462 U/L）。腹部和胸部X光片显示疑似气腹的影像。患者接受了急诊手术治疗，诊断为内脏穿孔。剖腹手术时，可见横结肠位于肝脏和膈肌之间，尽管未发现穿孔。由于精神分裂症爆发风险高，此前一直在进行精神科治疗。在接下来的48小时内，肠道蠕动恢复，患者在术后第40天出院，诊断为继发于精神药物的奥吉尔维综合征。奥吉尔维综合征与精神科治疗之间的关系是已知的，但奥吉尔维综合征与奇莱迪蒂综合征之间的关联非常罕见。然而，它可能被误诊为气腹并导致急诊手术。
