Chilaiditi sign is a rare incidental radiographic finding where bowel is interposed between the diaphragm and the liver, often seen as air under the right hemidiaphragm. A majority of patients with Chilaiditi sign are asymptomatic and remain so throughout their lifetime. Chilaiditi sign is recategorized as
Chilaiditi syndrome if it becomes symptomatic and is a very rare etiology of bowel obstruction. As bowel obstruction confers a huge financial burden to the health care system, studies of even the rarer etiologies are of significant value. Particularly in the case of
Chilaiditi syndrome, the free air under the right hemidiaphragm can lead physicians to prematurely conclude
pneumoperitoneum, which would require an emergent surgical evaluation. It is through the incorporation of a broad differential and clinical presentation that physicians can decrease the inappropriate allocation of hospital resources and unnecessary
surgical procedures; additionally, keeping
Chilaiditi syndrome on the differential may prevent unnecessary surgical intervention, cost to the patient, and downstream complications. Bowel obstruction secondary to
Chilaiditi syndrome is most commonly treated with
conservative management including intravenous fluids, bowel rest,
decompression, and laxatives. If the symptoms worsen and progress to full bowel obstruction, surgical intervention has shown great efficacy. We report a case of a 69-year-old male who presented to the emergency department for progressively worsening
abdominal pain,
nausea, and
vomiting incidentally found to have colonic interposition with mild colonic dilatation on computed tomography (CT) imaging. The patient was diagnosed with bowel obstruction secondary to
Chilaiditi syndrome and treated non-surgically with rapid recovery.