Thread by @DIskandarmirza

For Junior Doctors

Have you guys heard of Chiladaiti syndrome?

I'm sharing my case from HTAN, Pilah and how I managed this case.

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62 y.o guy with
- PTB on intensive phase day 40
- dm
- hypertension
- dyslipidemia

Came with right hypochondriac and epigastric tenderness
- associated with nausea and vomiting
- no fever
- reduced oral intake
- able to pass flatus and BO
- no aggravating or relieving factor

Cxr
- showed consolidation over right upper zone
- bowel shadow below right diaphragm

Patient was treated for chiladaiti syndrome
- ryles tube free flow
- keep nil by mouth
- lactulose 15 mls tds
- IVD for hydration

After 5 days of treatment:

- symptoms improved
- able to tolerate orally
- repeated cxr no more bowel shadow below right hemi-diaphragm.

Colonic interposition is usually an asymptomatic radiologic sign.

The most common symptoms are gastrointestinal (eg, abdominal pain, nausea, vomiting, and constipation), followed by respiratory distress and less frequently, chest pain

Complications of Chilaiditi syndrome may include a volvulus of the cecum, splenic flexure, or transverse colon.

Cecal perforation and, rarely, perforated subdiaphragmatic appendicitis can also occur as complications of Chilaiditi syndrome

No intervention is required for an asymptomatic patient with Chilaiditi sign.

When evaluating a symptomatic patient with small bowel obstruction, clinicians should first rule out the more serious condition of pneumoperitoneum.

Initial management of Chilaiditi syndrome should include bed rest, intravenous fluid therapy, bowel decompression, enemas, and laxatives.

A repeat radiograph following bowel decompression may show disappearance of the air below the diaphragm.

If the patient does not respond to initial conservative management, and either the obstruction fails to resolve or there is evidence of bowel ischemia, then surgical intervention is indicated.