# Chilaiditi’s Syndrome Mimicking Crohn’s

## TL;DR

This paper reports a case where Chilaiditi’s syndrome was mistaken for Crohn’s disease, highlighting the importance of considering this rare condition in patients with unexplained abdominal symptoms.

## Contribution

The novelty lies in presenting a clinical case where Chilaiditi’s syndrome mimicked Crohn’s disease and was successfully treated with surgery.

## Key findings

- A 21-year-old male with symptoms resembling Crohn’s colitis was diagnosed with Chilaiditi’s syndrome.
- Symptoms resolved after a right laparoscopic colectomy, confirming the syndrome as the cause.
- The case emphasizes the need to consider Chilaiditi’s syndrome in the differential diagnosis of unexplained abdominal pain.

## Abstract

Chilaiditi’s sign (colonic interposition) is a rare anomaly due to an abnormally located portion of the colon that is interposed in between the liver and the diaphragm. This rare anomaly is often incidentally seen on chest or abdominal radiographs. Chilaiditi’s radiographic sign is usually asymptomatic, whereas the medical condition accompanied by clinical symptoms is termed Chilaiditi’s syndrome. Possible causes of the syndrome include a long and mobile colon, scarring of the liver (cirrhosis), ascites, long-standing lung disease, as well as laxity of the falciform ligament. The most common clinical signs of Chilaiditi’s syndrome include gastrointestinal symptoms; however, clinical presentation can vary. This report describes a case of a 21-year-old male patient who presented with a longstanding history of left upper quadrant epigastric abdominal pain with diarrhea (six to eight loose watery stools). The patient was diagnosed with Crohn’s colitis and had tried a myriad of medical therapies with no adequate response. He chose to seek a second opinion and was subsequently discovered to have Chilaiditi’s syndrome via computed tomography (CT) and confirmed by barium enema. The patient then elected to undergo a right laparoscopic colectomy to resolve the symptoms. By postoperative day five, all symptoms had resolved including abdominal pain and diarrhea. Therefore, it is important to consider Chilaiditi’s syndrome as a differential diagnosis in persons presenting with left upper quadrant pain and symptoms of Crohn’s colitis, especially those treated with adequate medical therapy without alleviation of symptoms.