Journal of Applied Hematology

IMAGE IN HEMATOLOGY
Year
: 2022  |  Volume : 13  |  Issue : 4  |  Page : 289--290

Bilateral chilaiditi syndrome in a child with sickle cell trait


Muneer H AlBagshi1, Fatimah A Alaithan2,  
1 Department of Pediatrics, Almana General Hospital, Al Ahsa, Hofuf, Saudi Arabia
2 Department of Radiology, Dammam Medical Tower, Dammam, Saudi Arabia

Correspondence Address:
Dr. Muneer H AlBagshi
Department of Pediatrics, Almana General Hospital, Al Ahsa, Hofuf
Saudi Arabia




How to cite this article:
AlBagshi MH, Alaithan FA. Bilateral chilaiditi syndrome in a child with sickle cell trait.J Appl Hematol 2022;13:289-290


How to cite this URL:
AlBagshi MH, Alaithan FA. Bilateral chilaiditi syndrome in a child with sickle cell trait. J Appl Hematol [serial online] 2022 [cited 2023 Jan 27 ];13:289-290
Available from: https://www.jahjournal.org/text.asp?2022/13/4/289/358712


Full Text

A 10-year-old boy presented with recurrent abdominal pain for several months and constipation. He denied presence of vomiting, bloody stool, or abdominal distention. He was treated as sickle cell disease painful crisis because strong family history. A physical examination was otherwise unremarkable. Complete blood count showed hemoglobin (Hb) of 12.7 g/dl, white blood count of 3.55 × 103. Hb electrophoresis confirmed sickle cell trait; Hb: A - 61.3%, S - 34.5%, F - 0.9%, A2-3.3%. A plain abdominal radiograph showed bilateral abnormal gaseous shadows of colon, the right side the colon between diaphragm and the liver, whereas the left side colonic shadow was between the spleen and diaphragm as shown in [Figure 1]. Based on his history and presence of radiological signs, he was diagnosed with Chilaiditi syndrome. Conservative management with mild laxatives and a high-fiber diet were prescribed. Chilaiditi syndrome reported in 1910 by a Greek radiologist Demetrius Chilaiditi who described hepato-diaphragmatic interposition of the bowel, usually involving the transverse colon.[1] Although most of the patients are asymptomatic, few develop recurrent abdominal pain, constipation, or it may cause volvulus. Chest pain may occur as result of the distended colon pressing on the diaphragm.[2] In areas where sickle cell disease is prevalent careful review of history and clinical examination with support by Hb electrophoresis to document the patient status to avoid unnecessary interventions. Furthermore, serious conditions may be confused with it like pneumoperitoneum or diaphragmatic hernia. Chilaiditi sign on plain radiographs show gas between the liver and the diaphragm; rugal folds within the gas suggest that it is colonic haustration and not free gas. In case of clinical suspicion of abdominal visceral perforation, then computed tomography may be indicated. Conservative management is often sufficient in a child with symptomatic Chilaiditi syndrome. Surgical intervention is indicated in the presence of intestinal perforation or obstruction.[2],[3]{Figure 1}

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

References

1Chilaiditi D. On the question of hepatoptosis ptosis and generally in the exclusion of three cases of temporary partial liver displacement. Fortschr Geb Röntgenstr Nuklearmed 1910;11:173-208.
2Nichols BW, Figarola MS, Standley TB. A wandering liver. Pediatr Radiol 2010;40:1443-5.
3Fiumecaldo D, Buck L. Chilaiditi's syndrome causing high-grade small-bowel obstruction requiring exploratory laparotomy. Mil Med 2018;183:e281-3.