EP 087 A Rare Case of Concurrent Chilaiditi Syndrome and Acute Appendicitis: An Uncommon Diagnostic Dilemma
Rafique Umer Harvitkar, Seshu Bylapudi, Neriah Mangion, Ioannis Hannadjas, Alfredo Tonsi, Nida KhanAbstract
Introduction
Chilaiditi syndrome is a rare anatomical variant characterised by interposition of the colon between the liver and diaphragm. It is usually an incidental radiological finding and is often asymptomatic, but may occasionally present with gastrointestinal symptoms or complications. Its coexistence with acute appendicitis is exceptionally rare and creates diagnostic difficulty because pain may localise atypically.
Case Presentation
A 60-year-old female presented with a two-day history of right upper quadrant abdominal pain, fever, nausea, and vomiting. Clinical assessment and laboratory investigations initially suggested acute cholecystitis. Contrast-enhanced CT imaging demonstrated interposition of the right colon between the liver and diaphragm, consistent with Chilaiditi syndrome, with displacement of the caecum and appendix into the right upper quadrant. The appendix was dilated with surrounding inflammatory change, consistent with acute appendicitis and impending perforation. The patient underwent emergency laparoscopic appendicectomy. Intraoperatively, the appendix was identified over the right lobe of the liver within the interposed colon. Appendicectomy was completed safely without manipulation of the large bowel. Postoperative recovery was uncomplicated, and the patient was discharged on postoperative day two.
Discussion
Chilaiditi syndrome may obscure the diagnosis of acute abdominal pathology, particularly when symptoms mimic hepatobiliary disease. Cross-sectional imaging is essential for accurate diagnosis and operative planning in atypical presentations. Laparoscopic surgery provides excellent visualisation and allows safe management despite distorted anatomy.
Conclusion
Chilaiditi syndrome should be considered in patients presenting with atypical right upper quadrant pain. Early CT imaging and prompt laparoscopic intervention enable accurate diagnosis and favourable surgical outcomes in selected cases.