Successful conservative management of Chilaiditi syndrome in a 6-year-old boy: a case report

Chilaiditi syndrome (CS) is a rare clinical entity in which a portion of the colon becomes interposed between the liver and the diaphragm. It can potentially mimic pneumoperitoneum and lead to unnecessary surgical interventions. A 6-year-old boy with a known history of idiopathic exocrine pancreatic insufficiency and chronic constipation since the age of 4 years was brought to the emergency department with a four-week history of intermittent abdominal pain and progressive distension. Initial upright abdominal radiographs revealed bilateral subdiaphragmatic colonic air with visible haustral markings and a large fecaloma, consistent with Chilaiditi syndrome. The patient was not kept NPO but did not tolerate his oral intake well. He was managed conservatively with intravenous fluids, acetaminophen (15 mg/kg every 6 hours), phloroglucinol (40 mg twice daily), and daily rectal enemas composed of 400 mL saline and 15 mL glycerin. A contrast enema performed on day 2 confirmed sigmoid and colonic distension due to a fecal impaction. He started passing stool two days after the enemas were initiated. A follow-up abdominal radiograph on day 3 showed complete resolution of the colonic interposition and the stool burden. The patient remained symptom-free and had no recurrence at 6 months of follow-up. Chilaiditi syndrome should be considered in children with abdominal pain who present air between the diaphragm and the liver, as this condition can mimic pneumoperitoneum but typically does not require a surgical intervention.