What is Chilaiditi Syndrome?
Chilaiditi Syndrome is a medical term where in a part of the colon is interposed or abnormally located in between the liver and the diaphragm causing several different symptoms such as nausea, vomiting, abdominal pain and also small bowel obstruction. The hepato-diaphragmatic interposition of large intestine is called Chilaiditi syndrome and it is diagnosed as an incidental radiological findings.
Causes of Chilaiditi Syndrome
The exact cause of Chilaiditi syndrome is still not known, but predisposing factors might include laxity of falciform ligament, long mobile colon, emphysema, ascites and cirrhosis. Usually occurs in individuals with chronic lung disease, liver cirrhosis, and ascites. Sometimes there is elongation of liver also. Chilaiditi Syndrome is considered a rare cause of intestinal obstruction of large or small intestine. It is also observed that the colonic pseudo obstruction is found in patients suffering from Chilaiditi Syndrome. It has also been associated with pulmonary or gastrointestinal malignancies that include colon, rectum and stomach.
Symptoms of Chilaiditi Syndrome
Chilaiditi syndrome has a strong potential for confusion and may lead to error in diagnosis and lead to unnecessary laparoscopy. The folds in the intestine will help to diagnose or distinguish from the free air under the diaphragm. Basically the symptoms of Chilaiditi syndrome vary. It is often found that mainly you come across chronic pain in the abdomen which is very common, but some of the other symptoms of Chilaiditi syndrome are nausea, vomiting, indigestion, constipation, swallowing becomes very difficult, tenderness in the abdomen, mostly on the upper abdomen and in the central abdominal area. If the case is serious then even you can come across breathing problem may sometimes develop.
The most important symptom of Chilaiditi syndrome is gastrointestinal such as abdominal pain, nausea, vomiting and also constipation. This may be followed by respiratory distress and sometimes angina like chest pain. The gastrointestinal symptoms can vary from mild to serious condition.
Recognizing the signs of Chilaiditi syndrome is very important or else one can mistake it to be Chilaiditi syndrome and advice for a surgery which could prove unnecessary.
The frequency of Chilaiditi syndrome varies from person to person, and accordingly it is found that in general population based on the radiographs it is observed that it is about 0.025% to 0.28%. It has also been found that in such cases there are chances of increasing number with age, having male predominance.
Tests to Diagnose Chilaiditi Syndrome
When test is done it is observed that the transposition of colon abnormally between the liver and the diaphragm is identified. Even while taking the chest X-ray or abdominal X-ray will show the transposition of colon in abnormal position.
To diagnose Chilaiditi syndrome signs from the radiology test one should know that:
- The right hemidiaphragm should be raised above the liver by the intestine.
- The bowel should be distended by air to show that pseudopneumoperitoneum and the edges of the liver should be depressed below the level of hemidiaphragm.
- With some of the patients with predisposing factors such as bowel hyper mobility can be the cause of Chilaiditi syndrome.
Colonoscopy in the setting of Chilaiditi syndrome may at times lead to perforation due to the trapping of the air, which is administered in an acutely in the segmented bowel due to the angular segments position. Secondly, in patients undergoing liver biopsies colonoscopy should be done with proper care, because of the abnormally placed bowel this syndromes air perforation is very likely particularly when the patient undergoes percutaneous transhepatic procedures. In such case usually surgery is advised by the doctors.
Treatment for Chilaiditi Syndrome
For Chilaiditi syndrome it does not require any specific treatment. The patients having Chilaiditi syndrome will be treated with analgesic or pain killer and fluid revival. Some of the patients are advised surgery in which ischemic bowel segments have to be removed if it is combined with colonic volvulus. The treatment is symptomatic and supportive. On certain studies it is found that Chilaiditi syndrome is first treated with conservative management that includes bed rest, nasogastric decompression, fluid supplementation, laxatives and enemas. Thereafter, a radiographic study is performed to assess for the degree of air under the diaphragm. If the management conservative treatment fails, surgical intervention is advised, this includes colopexy or colectomy.
No intervention is required for patients with any asymptomatic Chilaiditi sign. If there is any small obstruction pertaining to the bowels, doctors should first rule out the problem of pneumoperitoneum or else it might end in surgical intervention which is unnecessary.
Home Remedies for Chilaiditi Syndrome
Chilaiditi Syndrome does not require any specific home remedies, but you can take maximum rest and avoid eating gas producing food items. As far as possible avoid constipation.
Having proper food to avoid indigestion is very essential, so that it does not develop into acidity or any kind of gastric problem.
Lifestyle Changes for Chilaiditi Syndrome
The affected individuals need to be oriented about the condition, so that it can be managed properly. The patient should be told about the fact and that being in advanced condition need to undergo surgery and thereafter, it can be managed effectively managed. The surgery is performed to assure the recurrence free of the disease. These are some of the points, which one should remember about Chilaiditi syndrome. Simple diet and lifestyle changes can provide relief from Chilaiditi syndrome. Although it may take some time to give you immediate changes, but over a period of time it will help you a lot.
Prevention of Chilaiditi Syndrome
See that the food eaten is properly digested. Avoid eating food causing gastric problems to prevent Chilaiditi syndrome. Awareness about Chilaiditi syndrome and its signs is essential for each and every care providers during the practical workup as well as in the evaluation of routine abdominal pain. Care should be taken to predisposing patients to the development of Chilaiditi syndrome treatment with altering treatment.
The best way to prevent Chilaiditi syndrome is to adopt heart healthy lifestyle changes. Ensure to visit the doctor for routine check up for cholesterol, blood pressure, sugar level in blood etc. Lipid profile should be also done to know the triglycerides.
There are certain ways that can help you prevent or ease system such as:
- Counseling by a psychiatrist can help you reduce your tension and help you to relax, and then try to modify your behavior.
- Biofeedback is also helpful in preventing Chilaiditi syndrome. The stress reduction will help you reduce muscle tension and slow your heart rate. This will help you to enter a state of relaxing condition.
- Exercise for relaxing as it helps to relax the muscles of the body. it will help to tighten all the muscles, which will drain out all the tensions.
- Deep breathing exercises can help in managing Chilaiditi syndrome. Try to breathe from your diaphragm, which will allow your belly to expand.
- Stress reducing techniques for treating Chilaiditi syndrome will help you focus on being in the present moment and forgetting all the worries.
Risk Factors for Chilaiditi Syndrome
The most important risk factor for Chilaiditi syndrome is cirrhosis that may lead to liver atrophy, obesity, multiple pregnancies, ascites, and paralysis of the right diaphragm. It has been found that men are four times more affected with Chilaiditi syndrome than women. Especially, elderly men are at more risk as compared to women for developing Chilaiditi syndrome. In the same way people suffering from liver problem or lung problem can easily acquire this syndrome correctly a risk factor.
Complications of Chilaiditi Syndrome
Sometimes the patient develops breathing problem or lung problem. Complications of chilaidati syndrome may include a volvulus of the cecum, splenic flexure or transverse colon. Apart from this there are chances of cecal perforation, and also sub-diaphragmatic appendicitis occurrence is possible, although it is a rare case.
Prognosis/Outlook for Chilaiditi Syndrome
The prognosis/outlook for Chilaiditi syndrome is good. Patients with recurrent presentations or showing evidences of bowel ischemia may be given surgical treatment. Sometimes if such pains occur then colopexy may be sufficient to prevent future recurrence of system.
In the beginning, the patient is advised to go for bed rest, given intravenous fluid therapy, bowel decompression
Asymptomatic patients with Chilaiditi syndrome do not require any kind of specific treatment. Patients having abdominal pain or distension are normally treated with some analgesic and fluid resuscitation. Some of the patients have recurrent symptoms with some evidences of bowl ischemia will be directed to undergo surgical treatment. They will have to remove the bowel segments if there is colonic volvulus associated with it; or else colopexy may be sufficient to stop the recurrence of the symptoms in future.
Recovery Period/Healing Time for Chilaiditi Syndrome
Every patient has different complaints with Chilaiditi syndrome and every patient is recovered with respect to the complaints. Recognition of the symptom is more important because this syndrome can be mistaken for more serious abnormalities.
- Sutcliffe J, Hoyle C. Chilaiditi’s Syndrome. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2021. https://www.ncbi.nlm.nih.gov/books/NBK513326/
- Chilaiditi D, Zuckerman K. [Concerning the so-called hepatodiaphragmatic interposition of the intestine and superior right diaphragmatic flexure syndrome]. Zentralbl Chir. 1910;37:1725–1731. (Original description of Chilaiditi Syndrome)
- Radiopaedia. (2021). Chilaiditi Syndrome. https://radiopaedia.org/articles/chilaiditi-syndrome
- Kelly, H. A., & MacCallum, W. G. (1910). Pneumoperitoneum: a new method for its production and some of its effects. The Journal of the American Medical Association, 55(24), 1890-1895. (Early description of Chilaiditi Syndrome)
- Eren S, Kantarci M, Oğüt G, et al. Radiological imaging findings of Chilaiditi syndrome. Eur Radiol. 2003;13(2):389-392. doi:10.1007/s00330-002-1546-8