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Chilaiditi's Syndrome Causing High-Grade Small-Bowel Obstruction Requiring Exploratory Laparotomy
Daniel Fiumecaldo1, Lauren Buck1
1Department of General Surgery, Keesler Medical Center, 301 Fisher Street, Biloxi, MS 39534.
Military Medicine
|February 8, 2018
Summary
Chilaiditi's syndrome, where the intestine is above the liver, can cause small-bowel obstruction. This case highlights that prior abdominal surgery may necessitate earlier surgical intervention for this condition.
Area of Science:
- Gastroenterology
- Radiology
- Abdominal Surgery
Background:
- Chilaiditi's sign is a radiological finding of intestinal interposition in the sub-diaphragmatic space.
- While often asymptomatic, Chilaiditi's syndrome presents with symptoms like abdominal pain and nausea.
- Operative intervention for Chilaiditi's syndrome is typically associated with large bowel obstruction or colonic volvulus.
Purpose of the Study:
- To report a case of Chilaiditi's syndrome causing high-grade small-bowel obstruction.
- To discuss the implications of prior abdominal surgery on the management of Chilaiditi's syndrome.
Main Methods:
- Case report of a 57-year-old female presenting with Chilaiditi's syndrome.
- Review of patient's history, symptoms, and diagnostic findings.
- Description of surgical intervention following failure of non-operative management.
Main Results:
- The patient experienced a high-grade small-bowel obstruction due to Chilaiditi's syndrome.
- Non-operative management failed, necessitating exploratory laparotomy.
- Adhesions superior to the liver were identified, contributing to the obstruction.
Conclusions:
- Patients with a history of abdominal surgery may have a lower threshold for surgical management of Chilaiditi's syndrome.
- Concomitant adhesive disease, especially after upper abdominal surgery, increases the risk of complications.
- Further studies are needed to establish the failure rate of non-operative management for Chilaiditi's syndrome.