Abstract
A 74-year-old man, who had been diagnosed as having intestinal obstruction and had been treated at a hospital, was transferred to our hospital because of exacerbation of the symptom. An abdominal X-ray film and enhanced CT scan of the abdomen revealed bowel intrusion between the liver and right diaphragm, and air fluid levels in the whole abdomen. These findings established the diagnosis of Chilaiditi's syndrome. A barium enema revealed no abnormal findings, but a small bowel series proved interposition of the small bowel without involvement of the colon. After decreasing the bowel pressure, we performed a laparoscopic-assisted operation. At surgery, fibrous adhesion between liver and right diaphragm was identified, and the small bowel was trapped into the adhesion from the left side. Partial resection of the jejunum with primary anastomosis was performed via a small laparotomy. Chilaiditi's syndrome associated with obstruction of the small intestine is uncommon, and only about twenty cases have been reported in the Japanese literature. This is the first case report of a laparoscopicassisted operation for Chilaiditi's syndrome. For an accurate diagnosis and less invasive surgery, an appropriate combination of preoperative examination and laparoscopic-assisted surgery is worth a trial.
