Annals of Case Reports and Clinical Studies (ISSN: 2834-5673) | Volume 2, Issue 2 | Case Report | Open Access DOI

Left Colonic Interposition Mimicking Acute Abdomen: A Case Report

Emanuele Asti*

Pamela Milito, Marco Sozzi, Valentina Riggio, Massimo Cressoni, Stefano Siboni, Emanuele Asti*

Department of Emergency and General Surgery, University of Milan, IRCCS Policlinico San Donato, Italy

*Correspondence to: Emanuele Asti 

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The radiological sign of colonic interposition between the liver and the diaphragm was firstly reported and named by a Greek radiologist, Demetrius Chilaiditi, in 1910. The first three cases were asymptomatic patients who had the appearance of intra-abdominal free air under the right diaphragm on routine abdominal or chest x-ray [1].

Clinical presentation may vary, ranging from asymptomatic patients with incidental finding to patients complaining of a wide range of gastrointestinal symptoms like abdominal pain, bloating, nausea or vomiting. Extra-gastrointestinal symptoms such as dyspnea, chest pain and arrhythmias are rare [2-4].

The incidence of the sign is very low, accounting for 0.025% to 0.28% worldwide, with a higher prevalence between males older than 60 years old [2]. Factors favoring the Chilaiditi’s sign include anatomical variations such as absence or laxity of the falciform liver ligament or the transverse colon suspensory ligament, congenital malrotation or functional disorders like obesity or right diaphragmatic paralysis [5]. The most frequent bowel segment involved is the hepatic flexure, however small bowel or splenic flexure have also been described in a limited number of patients [6].

Despite the radiological sign is well known, abdominal pain or gastrointestinal symptoms might lead the physician to misdiagnosis and lead to unnecessary surgeries, especially in an emergency setting.

In this report we present a case of 60-year-old woman with acute abdominal pain and Chilaiditi’s sign due to sigmoid dolichocolon mimicking acute abdomen.



Pamela Milito, Marco Sozzi, Valentina Riggio, Massimo Cressoni, Stefano Siboni and Emanuele Asti.Left Colonic Interposition Mimicking Acute Abdomen: A Case Report.Ann Case RepClinStud.2023;2(2):1-5.