Mohamed Aisha O K, Mohamed Alzhara O K, Ibrahim Malaz I
Radiology Department, Omdurman islamic university, Al-Mahdi Street, Omdurman, Sudan.
MRCS - Royal College of edinburgh, Edinburgh, Nicolson Street, Scotland, UK, 2020.
Radiol Case Rep. 2024 Jun 21;19(9):3824-3828. doi: 10.1016/j.radcr.2024.05.026. eCollection 2024 Sep.
Chilaiditi syndrome is defined as the interposition of the colon between the liver and the diaphragm or abdominal wall and is known as Chilaiditi's sign on X-rays. Although rare, this procedure can lead to serious complications. Due to its infrequency and propensity for severe complications, diagnosing and differentiating this syndrome from other acute abdominal emergencies are very important for preventing unnecessary treatment or surgical procedures. We present a 72-year-old male with a history of chronic obstructive pulmonary disease (COPD) who presented to the emergency department with persistent shortness of breath, abdominal discomfort, and vomiting. Physical examination revealed chest crepitation, tenderness in the left iliac fossa, and high blood pressure. Laboratory tests revealed a positive COVID-19 status, elevated C-reactive protein level, and respiratory alkalosis. Imaging, including a chest X-ray and CT scan, confirmed the presence of bowel loops under the diaphragm, confirming the diagnosis of Chilaiditi syndrome. Collaborative management by surgical and medical teams was essential in navigating this complex condition. This case highlights the complexity of chilaiditi syndrome, which can be episodic and intermittent, in addition to the importance of recognizing Chilaiditi's sign on imaging, particularly on CT scans, to differentiate it from pneumoperitoneum. Vigilance is crucial in identifying potential complications and guiding appropriate treatment to prevent adverse outcomes.
奇莱迪蒂综合征的定义为结肠位于肝脏与膈肌或腹壁之间，在X射线上表现为奇莱迪蒂征。尽管罕见，但该病症可导致严重并发症。由于其发病率低且易引发严重并发症，因此将该综合征与其他急性腹部急症进行诊断和鉴别，对于避免不必要的治疗或外科手术非常重要。我们报告一例72岁男性患者，有慢性阻塞性肺疾病（COPD）病史，因持续气短、腹部不适和呕吐就诊于急诊科。体格检查发现胸部有捻发音、左髂窝压痛和高血压。实验室检查显示新冠病毒检测呈阳性、C反应蛋白水平升高以及呼吸性碱中毒。包括胸部X线和CT扫描在内的影像学检查证实膈肌下方存在肠袢，确诊为奇莱迪蒂综合征。外科和医疗团队的协作管理对于处理这一复杂病情至关重要。该病例突出了奇莱迪蒂综合征的复杂性，其可能呈发作性和间歇性，此外还强调了在影像学检查（尤其是CT扫描）中识别奇莱迪蒂征以将其与气腹相鉴别的重要性。警惕对于识别潜在并发症和指导适当治疗以预防不良后果至关重要。
