Rare Case of a Psychiatric patient presenting with Chilaiditi's syndrome

Dr.Vasileiadis P and colleagues have presented a Case of a Psychiatric patient presenting with Chilaiditi's syndrome that has appeared in Clinical Schizophrenia Related Psychoses 2018. The authors have tried to highlight the importance of accurate diagnoses of Chilaiditi's syndrome in patients with psychotic disturbances.

Chilaiditi's sign is defined as the interposition of bowels between the liver and the right diaphragm. Chilaiditi's sign was first documented in 1865 and is an incidental radiographic finding of bowel positioned between the liver and the right diaphragm. When the patient is symptomatic due to the intestinal obstruction, the case is termed as Chilaiditi's syndrome.

According to the history, a 46 years old male was admitted to the hospital with complaints of constant epigastric and right upper quadrant pain with radiation to the right shoulder. He had pain almost 10 hours before the admission and there was associated vomiting also. Patient has a history of schizophrenia and intellectual disability. He was agitated and excited and unable to give any information about his state of health.

On examination, the patient was afebrile, had tachycardic and his laboratory results were normal. The chest and abdomen x-ray showed the Chilaiditi's sign. An ultrasound and diagnosis of pneumoperitoneum was excluded. The patient was given conservative treatment including IV fluids, pain management medicines, diet modification, laxatives and enemas. After a week of admission, the patient felt better, started having a proper diet and regular evacuations and the Chilaiditi's sign disappeared.

The authors have emphasized that aetiology of the Chilaiditi's syndrome is multifactorial and it has been reported to be associated with psychotropic medication and intellectual disability. Therefore diagnosis of the syndrome is important in order to avoid unnecessary and dangerous surgical interventions because only very few publications of a Chilaiditi syndrome in patients with psychosis have been cited in the literature.

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PMID: 29944423 DOI: 10.3371/CSRP.VAMA.061518