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Chilaiditi Syndrome Caused by Fitz-Hugh-Curtis: Ultrasound and Computed Tomography Findings
Colm Michael Mulvany1, Andrew Nguyen2, Sarah Bella3
1Emergency Medicine PGY-1, New York-Presbyterian Brooklyn Methodist Hospital, Brooklyn, New York.
Insights
Point-of-care ultrasound (POCUS) effectively identified Chilaiditi Syndrome (CS), a rare bowel obstruction, in a patient presenting with right upper quadrant pain. This case highlights POCUS utility in diagnosing uncommon conditions secondary to Fitz-Hugh-Curtis Syndrome (FHCS).
Area of Science:
- Gastroenterology
- Radiology
- Emergency Medicine
Background:
- Chilaiditi Syndrome (CS) involves bowel entrapment between the liver and diaphragm.
- Anatomical distortions, like hepatic adhesions, are risk factors for CS.
Purpose of the Study:
- To demonstrate the utility of Point-of-Care Ultrasound (POCUS) in diagnosing Chilaiditi Syndrome (CS).
- To highlight the association of CS with Fitz-Hugh-Curtis Syndrome (FHCS).
Main Methods:
- A 50-year-old female presented with right upper quadrant pain.
- Point-of-care ultrasound (POCUS) suggested bowel obstruction.
- Contrast-enhanced CT confirmed incarcerated bowel loops, characteristic of CS.
- Laparoscopy revealed adhesions consistent with Fitz-Hugh-Curtis Syndrome (FHCS).
Main Results:
- POCUS identified findings concerning for bowel obstruction.
- CT imaging confirmed Chilaiditi Syndrome.
- Laparoscopy identified Fitz-Hugh-Curtis Syndrome adhesions as the cause.
Conclusions:
- POCUS is valuable for visualizing rare bowel obstructions like CS.
- CS can be secondary to Fitz-Hugh-Curtis Syndrome (FHCS).
- Emergency physicians should be aware of POCUS's role in diagnosing CS.
Background:
Chilaiditi Syndrome (CS) is the entrapment of the small bowel or colon between the liver and right hemidiaphragm. Risk factors include anatomical distortions of the right upper quadrant, such as adhesions from the anterior hepatic capsule.
Case Report:
A 50-year-old female with no prior surgical history presented to our emergency department (ED) complaining of right upper quadrant pain. Point of care ultrasound (POCUS) findings were concerning for a bowel obstruction. Contrast-enhanced computed tomography (CT) abdomen and pelvis demonstrated incarcerated small bowel loops into the hepatodiaphragmatic space characteristic of CS and on subsequent laparoscopy adhesions characteristic of Fitz-Hugh-Curtis Syndrome (FHCS) were identified and lysed.
Why Should An Emergency Physician Be Aware Of This:
This case demonstrates the utility of POCUS in visualizing a rare form of bowel obstruction and in identifying CS, in this instance secondary to FHCS.
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