Chilaiditi's Syndrome Mimicking Crohn's

Area of Science:

• Gastroenterology
• Radiology
• Surgical Pathology

Background:

• Chilaiditi's sign is a rare radiographic finding of colonic interposition between the liver and diaphragm.
• While often asymptomatic (Chilaiditi's sign), symptomatic cases are termed Chilaiditi's syndrome, linked to factors like colonic mobility and liver disease.

Observation:

• A 21-year-old male with persistent left upper quadrant pain and diarrhea, initially diagnosed with refractory Crohn's colitis.
• Imaging revealed Chilaiditi's syndrome, a condition not previously suspected despite extensive medical treatment.

Findings:

• Computed tomography (CT) and barium enema confirmed colonic interposition.
• Surgical resection (right laparoscopic colectomy) led to complete resolution of abdominal pain and diarrhea.

Implications:

• Chilaiditi's syndrome should be considered in the differential diagnosis for patients with left upper quadrant pain and symptoms suggestive of Crohn's colitis, particularly when medical therapy is ineffective.
• This case underscores the importance of comprehensive diagnostic evaluation to identify rare anatomical anomalies that can present with common gastrointestinal symptoms.
• Surgical management can be highly effective in alleviating symptoms associated with symptomatic Chilaiditi's syndrome.