- Email: [email protected]
Chilaiditi syndrome in a peritoneal dialysis patient
nephrology image
http://www.kidney-international.org & 2014 International Society of Nephrology
Kidney International (2014) 86, 214; doi:10.1038/ki.2013.486
Chilaiditi syndrome in a peritoneal dialysis patient Marie Ito1, Yoshikuni Nagayama1, Yuichi Maruta1, Hiroki Nishiwaki1 and Ashio Yoshimura1 1
Division of Nephrology, Department of Medicine, Showa University Fujigaoka Hospital, Yokohama, Japan
Correspondence: Yoshikuni Nagayama, Division of Nephrology, Department of Medicine, Showa University Fujigaoka Hospital, 1-30 Fujigaoka, Aoba-ku, Yokohama 227-8501, Japan. E-mail: [email protected]
Figure 1 | Chest X-ray shows air under the right diaphragm with haustra of colon (arrows).
A 55-year-old woman with end-stage renal disease from IgA nephropathy started continuous ambulatory peritoneal dialysis (CAPD). Three months later, she was admitted with sudden onset of right flank pain. She had undergone total hysterectomy 2 years ago and PD catheter placement 8 months ago. On admission she was afebrile and abdominal examination showed no sign of peritoneal irritation. Chest X-ray revealed air under the right diaphragm with haustrations suggestive of colonic air (Figure 1). CAPD fluid and blood test detected no sign of peritonitis. Abdominal computed tomographic (CT) scan revealed interposed colon between the liver and the diaphragm (Figure 2). Analgesics did not relieve her pain. Given a possibility of volvulus, laparoscopic enteropexy was planned. However, the pain was abruptly relieved after drainage of CAPD fluid and the subsequent chest X-ray
214
Figure 2 | Computed tomographic (CT) scan shows the interposed colon between the liver and the diaphragm (arrows).
showed that the interposed colon was no longer present. She has not experienced relapse since the last 6 months. Chilaiditi sign is asymptomatic appearance of interposed bowl between the liver and the diaphragm. It is found with an incidence of 0.025–0.28% in X-ray and of 1.2–2.4% in abdominal CT. With the presence of clinical symptoms, the condition is referred to as ‘Chilaiditi syndrome’. This condition is usually treated conservatively but rarely surgery is indicated in case of ileus, perforation, and ischemia. The predisposing factors include ascites, pregnancy, and any other conditions leading to an enlarged space under the right diaphragm or hypermobility of intestines. DISCLOSURE
All the authors declared no competing interests.
Kidney International (2014) 86, 214
http://www.kidney-international.org & 2014 International Society of Nephrology
Kidney International (2014) 86, 214; doi:10.1038/ki.2013.486
Chilaiditi syndrome in a peritoneal dialysis patient Marie Ito1, Yoshikuni Nagayama1, Yuichi Maruta1, Hiroki Nishiwaki1 and Ashio Yoshimura1 1
Division of Nephrology, Department of Medicine, Showa University Fujigaoka Hospital, Yokohama, Japan
Correspondence: Yoshikuni Nagayama, Division of Nephrology, Department of Medicine, Showa University Fujigaoka Hospital, 1-30 Fujigaoka, Aoba-ku, Yokohama 227-8501, Japan. E-mail: [email protected]
Figure 1 | Chest X-ray shows air under the right diaphragm with haustra of colon (arrows).
A 55-year-old woman with end-stage renal disease from IgA nephropathy started continuous ambulatory peritoneal dialysis (CAPD). Three months later, she was admitted with sudden onset of right flank pain. She had undergone total hysterectomy 2 years ago and PD catheter placement 8 months ago. On admission she was afebrile and abdominal examination showed no sign of peritoneal irritation. Chest X-ray revealed air under the right diaphragm with haustrations suggestive of colonic air (Figure 1). CAPD fluid and blood test detected no sign of peritonitis. Abdominal computed tomographic (CT) scan revealed interposed colon between the liver and the diaphragm (Figure 2). Analgesics did not relieve her pain. Given a possibility of volvulus, laparoscopic enteropexy was planned. However, the pain was abruptly relieved after drainage of CAPD fluid and the subsequent chest X-ray
214
Figure 2 | Computed tomographic (CT) scan shows the interposed colon between the liver and the diaphragm (arrows).
showed that the interposed colon was no longer present. She has not experienced relapse since the last 6 months. Chilaiditi sign is asymptomatic appearance of interposed bowl between the liver and the diaphragm. It is found with an incidence of 0.025–0.28% in X-ray and of 1.2–2.4% in abdominal CT. With the presence of clinical symptoms, the condition is referred to as ‘Chilaiditi syndrome’. This condition is usually treated conservatively but rarely surgery is indicated in case of ileus, perforation, and ischemia. The predisposing factors include ascites, pregnancy, and any other conditions leading to an enlarged space under the right diaphragm or hypermobility of intestines. DISCLOSURE
All the authors declared no competing interests.
Kidney International (2014) 86, 214