1) Chilaiditi syndrome, first reported in 1865, is a rare condition where the colon is interposed between the diaphragm and liver. 2) It occurs more commonly in men and in certain Asian populations, possibly due to differences in diet and fiber consumption. 3) Chilaiditi syndrome is usually asymptomatic but can cause abdominal pain and distention. Diagnosis is made through imaging like x-rays and CT scans. Conservative treatment with decompression and bed rest is typically effective.

2. PRONOUNCIATION
• Pronounced “Ky-La-Ditty”

3. HISTORY
• First reported by Cantini in 1865
• Beclere first described the roentgenologic
findings in 1899
• Demetrius Chilaiditi in 1911

4. HISTORY
• Hepatodiaphragmatic interposition of colon (HDI) or
CHILAIDITI’S SYNDROME.
• Rare anomaly, sex ratio is 4:1, men to women
• Incidence in the Western countries ranges from 0.02 % to
0.2 %.
• A higher incidence observed in China, Iran and Siberia.
• Comparison of the incidence of HDI in China with those
from Western countries reveals an almost 2-fold increase.
• The typical Chinese diet is higher in fiber than the typical
Western diet
• It was suggested that this difference reflected consumption
of a higher fiber vegetarian diet in these areas.

6. Large film of the abdomen from a
single-contrast barium enema with the
patient in the supine position

7. Large film of abdomen from a double-
contrast barium enema with the
patient in the supine position

8. ETIOLOGY
Some authors attempted to explain the
etiology of this abnormality and classified the
factors into:
Intestinal factors :-
Malrotation,
Abnormally mobile or redundant loops with long
mesentery,
Gas distention

9. Diaphragmatic factors
Eventration
Phrenic nerve injury,
Hepatic factors
 Small or atrophic liver,
 Cirrhosis,
 Congenital defects of ligaments
 Suprahepatic veins

10. Enlarged lower thoracic outlet
 Emphysema
 Pregnancy and
Elevated intra-abdominal pressure

12. Types
Fig. 1. These figures illustrate schematically the three types of hepatodiaphragmatic
interposition (modified from Fukuchi Y et al [4]: 1) The hepatic flexure of transverse
colon protrudes into the right anterior subphrenic space (Chilaiditi's syndrome). 2) The
transverse colon protrudes into the right posterior subphrenic space (3). 3) The
stomach and colon protrude into the right extraperitoneal subphrenic space (4). (A=
frontal view, B= lateral view; BA = bare area; L = liver; RAS= right anterior subphrenic
space; RPS= right posterior subphrenic space; RES= right extraperitoneal subphrenic
space; S = spleen; St= stomach).

13. Diagnosis
• Diagnosis made by abdominal X-ray, USG in
deft hands and CT scan.
• Commonest anatomic anomaly is flaccidity
and elongation of hepatic and intestinal
suspensory ligaments
• Most commonly, interposition is an
asymptomatic roentgen finding and the
condition is diagnosed incidentally.

14. • Main features are abdominal pain and distention
with radiologic evidence of interposition of the
colon between the diaphragm and liver in the
erect position.
• The liver easily accommodates interposition of
the transverse colon by migrating to the midline.
• The proximal transverse colon would become
"trapped“ in the suprahepatic space.
• The transverse colon then would dilate and rotate
on its mesocolon and obstruct.

15. Chilaiditi sign

16. Pseudopneumoperitoneum
Causes :-
o Chilaiditi syndrome
o Curvilinear pulmonary collapse
o Uneven diaphragm
o Distended viscus
o Omental fat
o Subphrenic abscess
o Subpulmonary pneumothorax
o Intramural gas in pneumatosis
o Apposition of gas-distended loops mimicking the
double wall sign

17. • Chest radiograph shows three characteristic
radiologic features of symptomatic
interposition:
– 1) elevation of right hemidiaphragm;
– 2) distended, fixed interposed hepatic flexure;
– 3) downward displacement of the liver.

23. D/D
Pseudo-pneumoperitoneum
 Gastrointestinal gas
• Pseudo-wall sign = apposition of gas-distended bowel
loops
• Chilaiditi’s Syndrome
• Diaphragmatic hernia
• Diverticulum of esophagus I stomach I duodenum
 Extraintestinal gas
• Retroperitoneal air
• Subdiaphragmatic abscess

24. • The hallmark of therapy is conservative—nasogastric
decompression and bedrest.
• Rarely has surgical intervention been indicated.
• HDI has rarely been associated with various disorders such
as volvulus of the cecum, transverse or sigmoid colon,
internal hernia of stomach or colon, suprahepatic
appendicitis, paralytic ileus, primary carcinoma of lung, or
abdominal trauma
• With the increasing frequency of this cycle of interposition,
dilatation, and volvulus, the patient's lifestyle became
compromised.
• Vascular compromise to the bowel was a possible or even
likely result in the long term problems.