Chilaiditi's syndrome in children

[corrected] Chilaiditi's syndrome (CS) is the condition for which radiological evidence of symptomatic colonic interposition between the liver and diaphragm is presented, although the syndrome is infrequently seen.

We reviewed patients with CS in our hospital in the past 15 years (3 patients, from July 1990 to June 2005) and case reports in the literature (10 patients). The diagnosis was made by abdominal computed tomography or roentgenograms of the chest and abdomen.

There were thirteen patients (6 males, 7 females) enrolled in our study. Their ages ranged from 6 months to 11 years old. The predisposing factors included aerophagia (46.2%), diaphragmatic eventration (23.1%), constipation (23.1%), and abdominal blunt trauma (7.7%). The common clinical manifestations included abdominal pain (69.2%), vomiting (38.5%), abdominal distension (30.7%), constipation (23.1%), and respiratory distress (23.1%). The roentgenograms of the chest and abdomen (n=13) showed elevation of the right hemidiaphragm occupied with mass-like opacity. Abdominal computed tomography (n=4) revealed hepatodiaphragmatic colonic interposition. Most patients were managed conservatively (n=8). Only four patients with recurrent symptoms received surgical correction. All of them had relief of symptoms after treatment. CS appears to be a clinically and radiologically benign syndrome and has a good outcome. For its management, conservative treatment is the first-line option. Other methods includes surgery.

We concluded that this rare syndrome could be kept in mind when young children present with recurrent respiratory distress, abdominal distension or abdominal pain accompanied by predisposing factors such as aerophagia, constipation, diaphragmatic eventration, or blunt trauma. Operative correction is necessary if recurrent symptoms are present.