Successful conservative management of Chilaiditi syndrome in a 6-year-old boy: a case report

Abstract

Introduction

Chilaiditi syndrome (CS) is a rare clinical entity in which a portion of the colon becomes interposed between the liver and the diaphragm. It can potentially mimic pneumoperitoneum and lead to unnecessary surgical interventions.

Case presentation

A 6-year-old boy with a known history of idiopathic exocrine pancreatic insufficiency and chronic constipation since the age of 4 years was brought to the emergency department with a four-week history of intermittent abdominal pain and progressive distension. Initial upright abdominal radiographs revealed bilateral subdiaphragmatic colonic air with visible haustral markings and a large fecaloma, consistent with Chilaiditi syndrome. The patient was not kept NPO but did not tolerate his oral intake well. He was managed conservatively with intravenous fluids, acetaminophen (15 mg/kg every 6 hours), phloroglucinol (40 mg twice daily), and daily rectal enemas composed of 400 mL saline and 15 mL glycerin. A contrast enema performed on day 2 confirmed sigmoid and colonic distension due to a fecal impaction. He started passing stool two days after the enemas were initiated. A follow-up abdominal radiograph on day 3 showed complete resolution of the colonic interposition and the stool burden. The patient remained symptom-free and had no recurrence at 6 months of follow-up.

Conclusion

Chilaiditi syndrome should be considered in children with abdominal pain who present air between the diaphragm and the liver, as this condition can mimic pneumoperitoneum but typically does not require a surgical intervention.