Ogilvie Syndrome and Chilaiditi Syndrome: a Strange Association

Chilaiditi syndrome is a strange disease which includes the existence of Chilaiditi sign and other abdominal symptoms. Chilaiditi sign refers the interposition of the colon between the liver and diaphragm that could be misinterpreted to be a pneumoperitoneum. We present a 46-year-old male patient who was admitted in the hospital with constipation and abdominal oppressive pain located in the epigastric area. He showed signs of peritoneal irritation, no bowel sounds, hernias, or organ enlargements. Laboratory analysis only revealed CPK elevation (462 U/L). Abdominal and chest radiographs showed an image which suggested a pneumoperitoneum. The patient underwent emergency surgical treatment, under diagnosis of viscera perforation. At laparotomy, an interposition of the transverse colon between the liver and diaphragm were visualized, although no perforations were present. Psychiatric treatment was held until this moment due to the high risk of schizophrenia outbreak. During the next 48 h, intestinal transit was restored and he was discharged on postoperative day 40, diagnosed with Ogilvie syndrome secondary to psychotropics. The relationship between Ogilvie syndrome and psychiatric treatments is known, but the association between Ogilvie and Chilaiditi syndrome is very strange. Nevertheless, it could be misinterpreted like a pneumoperitoneum and led to the performance of emergency surgery.