Case Report
Copyright ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Pediatr. May 9, 2021; 10(3): 40-47
Published online May 9, 2021. doi: 10.5409/wjcp.v10.i3.40
Chilaiditi syndrome in pediatric patients - Symptomatic hepatodiaphragmatic interposition of colon: A case report and review of literature
Luis Caicedo, Paul Wasuwanich, Andrés Rivera, Maria S Lopez, Wikrom Karnsakul
Luis Caicedo, Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Nicklaus Children’s Hospital, Miami, FL 33155, United States
Paul Wasuwanich, Department of Medicine, University of Florida College of Medicine, Gainesville, FL 32610, United States
Andrés Rivera, Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York, NY 10092, United States
Maria S Lopez, Department of Pediatrics, Nicklaus Children’s Hospital, Miami, FL 33155, United States
Wikrom Karnsakul, Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD 21287, United States
Author contributions: Caicedo L, Rivera A, and Lopez MS collected data and drafted initial manuscript; Wasuwanich P collected data, carried out the formal analysis, and revised the manuscript. Karnsakul W conceptualized and designed the study, supervised the study, and revised the manuscript; all authors have reviewed the manuscript and approved the final manuscript as submitted and agree to be accountable for all aspects of the work; Caicedo L and Wasuwanich P are contributed equally to this study.
Informed consent statement: Informed written consent was obtained from the patient for publication of this report and any accompanying images.
Conflict-of-interest statement: The authors declare that they have no conflict of interest.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
Corresponding author: Wikrom Karnsakul, MD, Associate Professor, Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, Johns Hopkins University School of Medicine, CMSC-2 600 North Wolfe Street, Baltimore, MD 21287, United States.
Received: January 5, 2021
Peer-review started: January 5, 2021
First decision: January 25, 2021
Revised: February 4, 2021
Accepted: March 10, 2021
Article in press: March 10, 2021
Published online: May 9, 2021

Chilaiditi syndrome is a rare disorder characterized by the hepatodiaphragmatic interposition of the intestine.


Here we report a case of a 12-year-old male who was admitted to the pediatric intensive care unit secondary to abdominal pain and severe respiratory distress. He was treated conservatively but the symptoms persisted requiring a surgical approach. While there have been several cases of Chilaiditi syndrome reported in adults, there is a scarcity of cases reported in the pediatric population. Our review of the literature found only 30 pediatric cases, including our reported case, with Chilaiditi syndrome, 19 (63%) of which were male. The median age of diagnosis was 4.5 years old with an interquartile range of 2.0-10.0 years. In our review, we found that the most common predisposing factors in children are aerophagia (12/30 cases) and constipation (13/30 cases). Ninety percent of the cases presented with complete intestinal interposition, in 100% of which, the colon was involved. Three of the 30 cases were associated with volvulus.


In the pediatric population, conservative (21/30 cases) and surgical (8/30 cases) treatment approaches have produced satisfactory outcomes for all the patients, regardless of approach.

Keywords: Abdominal pain, Dyspnea, Constipation, Rare diseases, Respiratory insufficiency, Colon, Case report

Core Tip: We describe a pediatric case of Chilaiditi syndrome with successful treatment, as well as a literature review of all pediatric case reports of Chilaiditi syndrome. In the pediatric patients, both conservative and surgical approaches in treating Chilaiditi syndrome with treatment of predisposing factors have resulted in satisfactory outcomes.