The Treatment of Chilaiditi Syndrome: A Review Article

Abstract

Introduction: Chilaiditi’s sign is characterized by the interposition of bowel loops in the hepatodiaphragmatic region, leading to the incidental finding of subphrenic air. When symptoms related to this condition occur (especially gastrointestinal symptoms), it is referred to as Chilaiditi Syndrome (CS). This study is a systematic review of the literature on the treatment of CS, aiming to provide updates on a rare and underexplored topic that can lead to complications. Methodology: Using the PRISMA statement and the descriptors "Chilaiditi syndrome" and "treatment" in the Virtual Health Library, 41 articles were found. Results: After applying inclusion criteria (articles in English or Portuguese between 2019 and 2024) and excluding those that did not meet the criteria (animal studies, duplicate articles, articles unrelated to the topic, and incomplete studies), 10 articles remained. Discussion: The diagnosis of CS is usually incidental, identified through imaging exams that reveal the bowel located outside its usual space. Surgery is only performed in necessary cases (such as compromised bowel flow, signs of bowel ischemia, or life-threatening risks). Rest, fluid administration, symptomatic medication, and nasogastric or rectal decompression are good initial measures. Surgical options may involve bowel resection or simply repositioning and fixation to prevent recurrence. Conclusion: CS is a rare condition with differential diagnoses including subphrenic abscess and pneumoperitoneum. Treatment is mostly conservative. If the patient does not improve, more serious conditions or underlying diseases should be suspected, and the surgical team should be prepared to act.