An exceptional cause of dyspnea: The uncommon case report of the association between Chilaiditi syndrome and diaphragmatic eventration

Med Dheker Touati; Mohamed Raouf Ben Othmane; Fahd Khefacha; Anis Belhadj; Ahmed Saidani; Faouzi Chebbi

doi:10.1016/j.ijscr.2023.109008

An exceptional cause of dyspnea: The uncommon case report of the association between Chilaiditi syndrome and diaphragmatic eventration

Int J Surg Case Rep. 2023 Nov:112:109008. doi: 10.1016/j.ijscr.2023.109008. Epub 2023 Nov 4.

Authors

Med Dheker Touati¹, Mohamed Raouf Ben Othmane², Fahd Khefacha², Anis Belhadj², Ahmed Saidani², Faouzi Chebbi²

Affiliations

¹ General Surgery Department, Mahmoud El Matri Hospital, V59M+628, Ariana, Tunisia; Faculty of Medicine of Tunis, University of Tunis El Manar, R534+F9H, Rue de la Faculté de Médecine, Tunis, Tunisia. Electronic address: dhekertouati@hotmail.com.
² General Surgery Department, Mahmoud El Matri Hospital, V59M+628, Ariana, Tunisia; Faculty of Medicine of Tunis, University of Tunis El Manar, R534+F9H, Rue de la Faculté de Médecine, Tunis, Tunisia.

Abstract

Introduction and importance: Chilaiditi's syndrome, characterized by the abnormal positioning of the intestine between the diaphragm and liver, and diaphragmatic eventration, a condition marked by the permanent elevation of one side of the diaphragm, are both exceedingly uncommon medical conditions. Their co-occurrence is even rarer, with only a handful of documented cases in medical literature.

Case presentation: A 71-year-old male patient initially presented with shortness of breath and was subsequently diagnosed with both Chilaiditi's syndrome and diaphragmatic eventration. His medical history included episodes of abdominal pain, constipation, and a prior colonoscopy that revealed no abnormal findings. Thorough physical examinations and imaging studies confirmed these diagnoses, and the patient's treatment was conservatively managed with intravenous fluids and laxatives, resulting in a significant improvement in his symptoms. Subsequent regular follow-up assessments showed no recurrence of symptoms.

Clinical discussion: Chilaiditi's sign/syndrome is a rare condition involving colon interposition between the liver and diaphragm, often diagnosed incidentally during imaging. It mainly affects older men and can cause abdominal symptoms. Management is typically conservative, but surgery may be needed if symptoms persist or complications arise, especially in cases of colonic volvulus or ischemia. When encountering diaphragmatic air, consider a differential diagnosis to avoid unnecessary surgery. Simultaneous hepatodiaphragmatic colonic interposition and diaphragmatic eventration is extremely rare, with uncertain causation.

Conclusion: This case highlights the rarity of the combination of Chilaiditi's syndrome and diaphragmatic eventration. Conservative management led to a significant improvement in symptoms, underscoring the importance of early recognition to prevent complications.

Keywords: Chilaiditi syndrome; Diaphragmatic eventration; Dyspnea; Emergency; Mesh.

Publication types

Case Reports