Chilaiditi's Syndrome Causing High-Grade Small-Bowel Obstruction Requiring Exploratory Laparotomy

Chilaiditi's sign is a radiological finding that occurs when the small or large intestine is positioned superior to the liver in the sub-diaphragmatic space. This is typically an asymptomatic radiological sign, but when symptoms occur, e.g., abdominal pain, nausea, emesis, it is termed Chilaiditi's syndrome. Currently, majority of the cases of Chilaiditi's syndrome, described in the literature, requiring operative intervention are due to large bowel obstruction or colonic volvulus. The following is a single case report of a patient presenting to Keesler Medical Center in Biloxi, Mississippi. This report details a 57-yr-old female who has found to have Chilaiditi's syndrome causing a high-grade small-bowel obstruction. She failed non-operative intervention and required exploratory laparotomy, lysis of adhesions, and manual reduction of small bowel from the sub-diaphragmatic space. The rate of failure of non-operative management of Chilaiditi's syndrome has not been established. Our patient had a surgical history of laparotomy and was found to have adhesions superior to her liver. Patients with prior abdominal surgery may require a lower threshold for operative management for Chilaiditi's syndrome due to the possibility of concomitant adhesive disease particularly if the prior procedure involved the upper abdomen.