Fiumecaldo Daniel, Buck Lauren
Department of General Surgery, Keesler Medical Center, 301 Fisher Street, Biloxi, MS 39534.
Mil Med. 2018 May 1;183(5-6):e281-e283. doi: 10.1093/milmed/usx069.
Chilaiditi's sign is a radiological finding that occurs when the small or large intestine is positioned superior to the liver in the sub-diaphragmatic space. This is typically an asymptomatic radiological sign, but when symptoms occur, e.g., abdominal pain, nausea, emesis, it is termed Chilaiditi's syndrome. Currently, majority of the cases of Chilaiditi's syndrome, described in the literature, requiring operative intervention are due to large bowel obstruction or colonic volvulus. The following is a single case report of a patient presenting to Keesler Medical Center in Biloxi, Mississippi. This report details a 57-yr-old female who has found to have Chilaiditi's syndrome causing a high-grade small-bowel obstruction. She failed non-operative intervention and required exploratory laparotomy, lysis of adhesions, and manual reduction of small bowel from the sub-diaphragmatic space. The rate of failure of non-operative management of Chilaiditi's syndrome has not been established. Our patient had a surgical history of laparotomy and was found to have adhesions superior to her liver. Patients with prior abdominal surgery may require a lower threshold for operative management for Chilaiditi's syndrome due to the possibility of concomitant adhesive disease particularly if the prior procedure involved the upper abdomen.
奇莱迪蒂氏征是一种放射学表现，指小肠或大肠位于膈下间隙肝脏上方时出现的情况。这通常是一种无症状的放射学征象，但当出现症状，如腹痛、恶心、呕吐时，则称为奇莱迪蒂氏综合征。目前，文献中描述的大多数需要手术干预的奇莱迪蒂氏综合征病例是由大肠梗阻或结肠扭转引起的。以下是一名患者前往密西西比州比洛克西的基斯勒医疗中心就诊的单病例报告。本报告详细介绍了一名57岁女性，她被发现患有奇莱迪蒂氏综合征，导致高位小肠梗阻。她非手术治疗失败，需要进行剖腹探查、粘连松解以及将小肠从膈下间隙手动复位。奇莱迪蒂氏综合征非手术治疗的失败率尚未确定。我们的患者有剖腹手术史，发现其肝脏上方有粘连。既往有腹部手术史的患者，由于可能合并粘连性疾病，尤其是如果既往手术涉及上腹部，对于奇莱迪蒂氏综合征的手术治疗可能需要更低的阈值。
