A case report of Chilaiditi syndrome presenting with a small bowel obstruction in an elderly Ethiopian man: A potential case for a misdiagnosis.

Background: Chilaiditi syndrome is a rare disease that has ultimate clinical significance as it can result in misdiagnosis and serious consequences.

Methods: A 65-year-old male patient presented to our hospital with sudden onset of severe, crampy peri-umbilical abdominal pain of 12 h duration. This patient was referred to our hospital for surgical intervention as the patient was misdiagnosed to have generalized peritonitis. However, upon our evaluation, the patient had no sign of peritonitis, and the abdominal X-ray showed features of the Chilaiditi sign complicated with small bowel obstruction. On that account, Chilaiditi syndrome was diagnosed, and the patient successfully managed non-operatively. Chilaiditi syndrome is clinical features caused by hepatodiaphragmatic bowel interposition. It tends to occur in male elders and commonly involves a colon. In this case, however, a small bowel was also involved and even resulted in its obstruction, which is extremely rare. Chilaiditi syndrome has a radiologic finding that has similarities with that of a bowel perforation. As a result of these, they are commonly misinterpreted as pneumoperitoneum, and the patient can be subjected to a preventable laparotomy. Nevertheless, Chilaiditi's air under the diaphragm has distinctive radiological features, and there will not be peritonitis signs unless the entrapped bowel is strangulated.

Conclusions: Chilaiditi syndrome is a benign condition that doesn't need a laparotomy unless it is complicated. However, it should be remembered that air under the diaphragm of a bowel perforation is surgical emergency and needs to be ruled out.