Chilaiditi syndrome

Overview

Chilaiditi syndrome is a rare gastrointestinal condition in which a portion of the colon (usually the transverse colon) becomes interposed between the liver and the diaphragm, resulting in symptoms such as abdominal pain, bloating, nausea, or constipation. When this anatomical finding is present without symptoms, it is referred to as Chilaiditi sign. The syndrome is typically diagnosed incidentally on imaging studies and must be carefully distinguished from other serious conditions such as pneumoperitoneum (free air under the diaphragm).

Causes

The exact cause of Chilaiditi syndrome is not always clear, but it is generally related to anatomical or functional factors that allow the bowel to shift into an abnormal position. Possible causes include:

• Congenital anomalies: Such as a long or mobile colon (redundant colon)

• Weak or lax suspensory ligaments: That normally hold the liver or colon in place

• Small liver size: Seen in cirrhosis or atrophy, creating extra space under the diaphragm

• Chronic constipation or increased intra-abdominal pressure

• Previous abdominal surgery: That may have altered anatomical relationships

• Chronic lung diseases: Leading to hyperinflated lungs and pushing abdominal contents downward

Symptoms

While many individuals with Chilaiditi sign are asymptomatic, those with Chilaiditi syndrome may experience a range of gastrointestinal symptoms, including:

• Intermittent or persistent abdominal pain

• Abdominal bloating or distension

• Nausea and vomiting

• Constipation or difficulty passing stool

• Decreased appetite

• Shortness of breath: In rare cases due to diaphragmatic irritation

Severe or untreated cases may lead to complications such as bowel obstruction, volvulus (twisting of the colon), or ischemia.

Diagnosis

Chilaiditi syndrome is often diagnosed using imaging studies and careful clinical correlation. Key diagnostic steps include:

• Abdominal X-ray: May show air under the right hemidiaphragm, which mimics free air (pneumoperitoneum), but bowel markings help differentiate it

• CT scan of the abdomen: Provides a more detailed view, confirming interposition of the colon between the liver and diaphragm

• Ultrasound: Can help rule out other liver or gallbladder conditions

• Clinical evaluation: Essential to correlate imaging findings with symptoms and rule out surgical emergencies

Treatment

Treatment of Chilaiditi syndrome depends on the severity of symptoms and the presence of complications. In most cases, conservative (non-surgical) management is effective. Common treatments include:

• Bed rest and bowel rest: Temporarily limiting oral intake to allow bowel repositioning

• Laxatives or stool softeners: To relieve constipation and reduce colonic distension

• Nasogastric decompression: For severe abdominal distension or nausea

• Intravenous fluids and electrolyte correction

• Surgical intervention: Rarely required but may be necessary if complications like volvulus, obstruction, or ischemia occur. Options may include colopexy (fixation of the colon) or bowel resection.

Prognosis

The prognosis for Chilaiditi syndrome is generally good, especially in cases managed conservatively. Symptoms typically resolve with appropriate medical treatment. Recurrence is possible, particularly if the underlying anatomical or functional predisposition remains uncorrected. In rare cases involving complications, surgical treatment can provide a permanent solution. Long-term outcomes are excellent in the absence of associated gastrointestinal or liver disease.