Case 189: Abdominal pain
A 75 year old man is referred in from his hostel with abdominal pain and bloating. He has a history of chronic constipation and laxative use. The emergency department has arranged an erect chext xray and call you with the result.
1. What sign does the xray demonstrate?
Chilaiditi's sign or syndrome. This an anatomic variation where the hepatic flexure of the colon is located above the liver and below the diaphragm. It occurs usually in association with abnormalities of the falciform ligament and hepatic attachments to the diaphragm.
2. What treatment is required for this syndrome?
The condition requires no specific treatment and is usually an incidental asymptomatic finding. It's importance is that it mimics free gas under the diaphragm and may prompt unnecessary laparotomy.
Further Reading