This case, the target like lesion was a caecal volvulus. A target-like, or sausage like CT appearance is usually typical of intussusception but in A left lateral decubitus abdominal film may help in this distinction.Ĭoncomitant pneumoperitoneum may be more difficult to diagnose. The right then it is suggestive of both a diaphragm and a bowel wall present, and Chilaiditi’s sign is a possibility. If the thickness is almost equal to that of The thickness of the left hemidiaphragm should be less if it is just a simple pneumoperitoneum. The wall of the stomach with an underlying gastric bubble. The thickness on the left hemidiaphragm is usually an amalgamation of the right hemidiaphragm and Another feature to consider is the thickness of the diaphragm. Important to bear in mind that the anatomy of the diaphragm is dome shaped and that any elevation of the diaphragm due to a pneumoperitoneum will not always be evenly spread out, but may occur eitherĬentrally or at the peripheral edge. There should equally be a paucity of lung markings within this area if the right hemidiaphragm is raised although it is One element to scrutinize for is the haustral folds whichĬan establish the air beneath the diaphragm is contained within large bowel. Transverse colon volvulus in Japan and a sigmoid colon volvulus in Turkey but only for the first time with a caecal volvulus in the UK. Chilaiditi’s syndrome has been reported to occur with a Chilaiditi’s Syndrome is important because it can simulate pneumoperitoneum. Vomiting, respiratory distress and anorexia. Chilaiditi’s syndrome may involve: abdominal pain, constipation, The falciform ligament, Redundant colon, Aerophagia, Paralysis right hemidiaphragm, Chronic lung disease, Cirrhosis and Ascites. It may be present intermittently and factors contributing to its occurrence include: Absence of normal suspensory ligaments, Abnormality of It is more common in males and almost always in adults. Chilaiditi’s sign is seen in 0.1-0.25% of chest radiographs, and is frequently an incidental finding. Demetrius Chilaiditi first described this condition asĪn incidental radiological finding of hepatodiaphragmatic interposition of bowel in 1910. Usually the asymptomatic interposition of the bowel, commonly the hepatic flexure of the colon, between the liver and the right hemidiaphragm. perforated duodenal ulcer, or perforated diverticulum. Generally when we see air under the diaphragm the assumption is made that this may be due to a perforated viscus e.g. This was removed surgically with a modified right hemicolectomy The patient subsequently underwent a laparotomy under a general anaesthetic which revealed a caecal volvulus. The air under the diaphragm was in fact a dilated loop of bowel and further down in the right iliac fossa, a target-like lesion was seen and was thought to be an Twenty-four hours later, there was no change in her condition and she was sent for a CT It was decided that she would be treated conservatively.Ī nasogastric tube was inserted and she was kept nil by mouth and started on intravenous fluids and analgesia. The clinical picture did not tally with her radiological results. When she was re-examined, her findings remained the same.

Her chest radiograph showed air under the right hemi-diaphragm, and the presumption was made that this patient A diagnosis of small bowel obstruction was made. Her blood results showed a CRP of 31.5 and neutrophil 7.8 but were otherwise normal.

Tenderness in the epigastria and suprapubically. Her abdomen was soft with mild generalized distension, and On examination she was uncomfortable but her observations were stable and she was not tachycardic. Past medical history included hypertension and depression.

This patient presented with a three day history of colicky central abdominal pain and distension, with nausea and vomiting.

Gastric bubble in diabetic coma x ray