Case Report: Chilaiditi syndrome as an emergency diagnostic challenge: case report and literature review

<ns5:p>Background Chilaiditi syndrome is a rare condition caused by interposition of the colon between the liver and the diaphragm. In the emergency department, it may mimic pneumoperitoneum and represent a significant diagnostic challenge, potentially leading to unnecessary surgical interventions. Awareness of this condition and its imaging characteristics is essential for timely and accurate diagnosis. Case presentation A 70-year-old male with type 2 diabetes mellitus, hypertension, and Alzheimer’s disease presented with acute abdominal pain and constipation. Abdominal radiography showed subdiaphragmatic air, initially raising suspicion of pneumoperitoneum. Computed tomography confirmed colonic interposition consistent with Chilaiditi syndrome. The patient was managed conservatively with bowel rest, intravenous fluids, analgesics, and laxatives. Clinical improvement was observed within 48 hours, with complete resolution of symptoms. Follow-up at one week was unremarkable. Conclusions Chilaiditi syndrome is an uncommon but important diagnostic pitfall in emergency medicine. Proper recognition using imaging can prevent misdiagnosis and unnecessary surgery. Conservative management is effective in most uncomplicated cases. A review of the literature highlights the rarity of this condition, common diagnostic challenges, and recommended management strategies.</ns5:p>