eISSN: 1897-4317
ISSN: 1895-5770
Gastroenterology Review/Przegląd Gastroenterologiczny
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1/2020
vol. 15
 
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Letter to the Editor

Chilaiditi sign in a plain abdominal X-ray – why is it worth remembering?

Dominik A. Walczak
1
,
Paulina Walczak
2
,
Beata Pawłowska
3
,
Marek Czarnecki
1
,
Michał Wojtyniak
4

1.
Department of Oncological and Reconstructive Surgery, Maria Sklodowska-Curie National Research Institute of Oncology, Gliwice, Poland
2.
Department of Cardiology, John Paul II Memorial Hospital, Belchatow, Poland
3.
Department of Diagnostic Imaging, John Paul II Memorial Hospital, Belchatow, Poland
4.
Department of Surgery, John Paul II Memorial Hospital, Belchatow, Poland
Gastroenterology Rev 2020; 15 (1): 82–83
Online publish date: 2020/03/19
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Air observed under the right dome of the diaphragm on a plain X-ray of the abdominal cavity is most often the result of perforation of the gastrointestinal tract, and thus the indication for urgent surgical intervention. However, it should be remembered that such a symptom may also have a different aetiology, not necessarily requiring surgery. More than 100 years ago, the Greek radiologist Demetrius Chilaiditi described the incidental X-ray finding of transposition of the colon between the liver and the diaphragm, which may resemble free air in the peritoneal cavity [1, 2].
A 62-year-old male patient was admitted to the Emergency Department due to severe abdominal pain which had lasted for 3 days. Moreover, he reported nausea and lack of both flatulence and stool. He was treated for hypertension. He denied other diseases and prior surgical procedures. During physical examination, the abdomen was rigid in the epigastric area and painful in palpation; the Blumberg sign was negative. Auscultation of the bowel revealed hypoactivity. In the abdominal X-ray, air was visible under the right dome of the diaphragm (Figure 1). The radiologist suggested that it could be a loop of the large intestine.
Laboratory tests revealed high levels of serum amylase (3111 U/l) and leukocytosis (12.5  103/µl). The level of C-reactive protein was not elevated. The remaining laboratory test results were within normal limits. Due to the ambiguous clinical picture, a computed tomography (CT) of the abdomen was performed. It revealed infiltration around the tail of the pancreas and partially organised inflammatory changes between the back wall of the stomach and the body of the pancreas. A hepatic flexure of the colon was seen anteriorly to the right lobe of the liver (Figure 2). No free air was revealed in the peritoneal cavity. The patient was admitted to the surgical ward due to acute pancreatitis. An ultrasound examination of the abdomen excluded gallstones as the aetiology of the pancreatitis. Conservative treatment was administered, resulting in improvement of the general condition and relief of symptoms. The patient was discharged after 6 days of hospitalisation.
Chilaiditi sign in a plain X-ray of the abdomen is defined as the presence of air under the right hemidiaphragm. It is a result of a transposition of the colonic hepatic flexure between the liver surface and the dome of the diaphragm. In a few cases, approximately 3–5%, the small intestine is...


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