Chilaiditi Syndrome

What is Chilaiditi Syndrome?

Chilaiditi syndrome, which is pronounced as “ky-la-ditty”, is considered to be an uncommon medical condition. This was Greek in origin and was named after the person who first described the condition, Dimitrios Chilaiditi. He accidentally encountered this medical condition while he was working in Vienna. This condition is sometimes referred to as the Chilaiditi anomaly. This usually develops when a huge segment of the colon, specifically the transverse colon, becomes accidentally transposed in between the liver and the diaphragm. This condition doesn’t usually manifest any symptoms. The transposition of the colon can usually be detected either through an abdominal or chest x-ray. Adult males are commonly affected by this condition.


Anatomically speaking, the diaphragm is what separates the abdominal cavity from the chest. Though Chilaiditi syndrome does not usually trigger symptoms, at times this can be primarily manifested by abdominal pain. Other symptoms may also be present in the long run. The absence of symptoms but the presence of transposition of the right colon is actually referred to as the Chilaiditi sign. In the event that symptoms are present, the condition would then be referred to as Chilaiditi syndrome.

Chilaiditi syndrome often leaves surgeon baffled because this can be mistaken as another condition which include suphrenic abscess, perforated viscus and pneumoperitoneum or the presence of air in the abdominal cavity. Thus, deliberate diagnosis of the condition is extremely necessary for proper treatment. This often resolves through certain surgical procedures. This review aims to explain to you other important aspects that you should learn about the condition.

Symptoms

The clinical manifestation of Chilaiditi syndrome usually varies between individuals. In some reported cases, symptoms were not noted especially in the elderly people. However, when the condition is classified as Chilaiditi syndrome, group of symptoms may manifest and these include the following:

Abdominal pain - The majority of those who previously suffered from Chilaiditi syndrome may report abdominal pain. Other symptoms that may be present are:

  • Abdominal Distention
  • Anorexia
  • Bowel Torsion (Volvulus)
  • Constipation
  • Nausea/vomiting
  • Respiratory distress (Shortness of Breath)

These are just some of the symptoms that may be present in Chilaiditi syndrome. It is imperative to note for these because there’s a great chance that the latter would eventually progress to pneumoperitoneum or the presence of air in the abdominal cavity. Additionally, there are certain factors which increase one’s risk of developing Chilaiditi syndrome such as:

  • The absence of the transverse colon normal suspensory ligaments
  • The absence of the falciform ligament or the presence of abnormalities in it
  • Aerophagia
  • Right hemidiaphragm paralysis
  • People with chronic ascites, cirrhosis and lung disease

Diagnosis

The symptoms that may be present would help lead to the diagnosis of Chilaiditi syndrome. However, in the event that symptoms are absent, other diagnostic tests are found to be really useful in the diagnosis. Imaging studies play a crucial role so as Chilaiditi syndrome can be diagnosed and these normally include x-rays and CT scan. Cases of Chilaiditi syndrome are usually detected in 0.1% to 0.25% of the images that were taken.

Causes

Until this very moment the exact cause of Chilaiditi syndrome still remains unknown. However, health care specialists have found probable causes of this condition and these include the absence or weakness of the ligaments that suspend the transverse colon. This can also be due to the absence of the falciform ligament. But the primary cause is believed to be due to the very structure of the patient’s colon especially when it is considerably long and mobile which make it easier to get transposed in between the liver and the diaphragm. This is referred to as dolichocolon. Chilaiditi syndrome can also be brought about by the medial left lobe atrophy of the liver. Other conditions that can possibly result to the development of Chilaiditi syndrome include the following:

  • Ascites
  • Chronic lung problems (i.e. Emphysema, Bronchitis)
  • Liver diseases (i.e. Cirrhosis)

Treatment

The primary mode of treating Chilaiditi syndrome is through corrective surgery. However, a surgical procedure may only be done in emergency cases such that of the presence of volvulus and obstruction. Among the proposed surgery are partial resection of the bowel, detorsion and colopexy. However, undergoing surgery does not guarantee total recovery because the condition might still recur following the surgical operation.

The average hospital stay of most patients is around 10 days. There are also those who were being discharged after a 21-day stay at the hospital. During the first few days after the surgery, the patient has to be put under intravenous therapy then may resume oral feeding later on.

Many consequences are also to be expected after the surgery including frequent passing of stool. In some cases, the frequency of bowel movement is around 5 times daily and it has a semi-liquid consistency. Later on, the frequency of bowel movement would eventually drop. In one case reported, the bowel movement frequency is only twice daily two years following the surgery. By this time, the patient can eventually gain weight and live normally. However, at times the patient may still complain of abdominal pain, distention and that bloated feeling which may be triggered by the type of diet the patient has. Generally, the majority of patients who had undergone a surgery to correct Chilaiditi syndrome were able to return to their normal lives and do the activities of daily living with little or even without the assistance of other people. Surgery also entails low mortality and morbidity rate.

The affected individual and his or her significant others just need to be oriented about the condition so that this can be properly managed. It should also be explained alongside that this condition is a rare one and this can only be effectively managed through surgery, a subtotal colon resection and anastomosis to be exact. This procedure is ideally performed to assure recurrence-free from the disease. These are just some of the things that you should acquaint yourself about Chilaiditi syndrome.

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