Bilateral Chilaiditi Syndrome in a Nigerian Child with Severe Acute Malnutrition: A Case Report

Abstract Chilaiditi syndrome is characterised by abdominal pain, usually in the right upper quadrant, associated with a radiological finding of sub-diaphragmatic free air due to colonic interposition between the diaphragm and the liver. The Chilaiditi sign is the radiological finding of sub-diaphragmatic pneumoperitoneum due to colonic interposition between the diaphragm and the liver without any clinical symptom. It can be a source of diagnostic dilemma considering bowel perforation as a common differential leading to unnecessary exploratory laparotomy. We report a four-year-old boy who presented with abdominal pain, fever, abdominal distension and diarrhoea with intermittent long-standing constipation. A plain abdominal radiograph in the erect position showed bilateral sub-diaphragmatic free air with associated haustration markings in free air. He was managed conservatively with antibiotics and nutritional rehabilitation with remarkable clinical improvement. While evaluating a child with an acute abdomen, the radiographic finding of free sub-diaphragmatic air, which is discordant with clinical signs, should heighten the suspicion of Chilaiditi syndrome. Knowledge of Chilaiditi syndrome is essential to avoid unnecessary surgical intervention while considering bowel perforation as a common cause of sub-diaphragmatic air.