Introduction

Chilaiditi’s Syndrome is an uncommon and rare disorder in which a part of the colon slips between the liver and the right side of the diaphragm. This condition can not be harmful. It can be detected by X-ray and CT scan, in which it shows an air-filled in diaphragm.

• This condition may not show any destructive sign, but when it does, it only shows nausea, stomach pain, trouble breathing, and chest pain.
• It is a very rare condition; only 0.025% to 0.28% of people worldwide are affected by this.
• Older men experience it more frequently than women.
• It has a 4:1 ratio from male to female.
• It occurs at 60 years of age, and its exact cause is unknown.

Although this is a rare condition, it is still important because it can easily be mistreated due to confusion. The healthcare profession sometimes treats it as serious conditions like bowel perforation and twisting of the intestine. This can lead to unnecessary tests and surgery (Cortes et al., 2020).

In many cases, the treatment is simple, such as bed rest, fluid intake, and monitoring with time. But if the symptoms come back healthcare professionals suggest surgery. Previously, doctors suggested open surgery, but in the modern world, laparoscopic surgery can be done.

In this article, we discuss both open and laparoscopic surgery. and compare according to the result, which works well to cure the Chilaiditi Syndrome.

Understanding recurrent chilaiditi syndrome

What causes it?

It can happen when there is a very long mobile intestine that moves into the space between the liver and the diaphragm. This condition can happen due to medical and some structural factors.

Anatomical reason

The anatomical reasons include the structural causes:

• Long and flexible colon
• Weak or absent ligaments that hold organs
• Small liver
• Extra space under the diaphragm

Physiological reason

Physiological causes include the functional causes:

• Continuous constipation
• Lung problems, which cause a flattened diaphragm
• Excess body weight
• Fluid in the belly

Signs and complications

Some people feel discomfort and might experience:

• Pressure and pain in the belly
• Feeling weak and sick
• Trouble during bowel movements or signs of blockage
• Difficulty breathing because there is pressure generated on the lungs
• In some rare cases it shows the twist, lost blood flow, or burst

When surgery becomes necessary

The Chilaiditi’s Syndrome patient can be cured 80% with nonsurgical care such as bowel rest, hydration, and digestive support. The operation may be needed when the symptoms may come back and affect the daily routine. Surgery is also done due to some serious issues, such as blockage and lack of blood supply development.

Surgical treatment options

When is surgery considered?

Surgery is not the first option; the surgery option can be used in very severe conditions when it affects the patient's daily life. The surgery option can be done only when:

Bowel ischemia and obstruction happen.

Patients can not serve normally after conservative care.

Goals of surgery

The main aims of surgery are to remove the extra parts and return the parts to its normal position and relieve patient pain. Ideally, the surgeon aims to return the patient to how they were before this syndrome.

Open surgery approach

Procedure

The open surgery requires a cut in the abdomen. The surgeon does the big cut to reach the bowel directly. After this:

Then fix the bowel to the belly bowel.

Remove the extra part.

Cut the tissue that affects the bowel.

Advantage

Due to the large cut, the doctor sees the organ clearly.

Open surgery is useful when the bowel is twisted.

Disadvantages

The open surgery needs a big cut that’s why it is more invasive.

The big cut causes more pain, is higher risk and there is a long stay after surgery.

The big cut results in a high chance of infection due to the open wound.

Many open surgeries were performed unnecessarily, due to misdiagnosis of chilauritis's sign.

Laparoscopic surgery approach

Procedure

The procedure of laparoscopic surgery is cutting the skin and inserting the camera to diagnose the disease and disorder. It is usually used to examine the abdomen and pelvis abnormalities.

In this syndrome, the laparoscopic surgery is performed for:

Laparoscopic colopexy: fix the colon in the abdominal wall.

Segmental resection: if there is a part that disturbs the body activities such as part of the colon.

Advantages

Small cut.

Faster recovery.

Shorten hospital stay.

Minimal risk of invasion.

Several case studies highlight the benefits of laparoscopy. For instance, Takahashi et al. (2017) reported successful laparoscopic repair of a recurrent case with quick recovery (Takahashi et al., 2017). Similarly, Nori et al. (2023) described a patient who underwent laparoscopic surgery for obstruction due to Chilaiditi’s syndrome and recovered rapidly without complications (Nori et al., 2023).

Disadvantage

Expensive.

Requires surgical expertise.

Comparison table

Summary

Recurrent Chilaiditi’s syndrome is a rare but challenging condition that often requires surgery when conservative management fails. Both open and laparoscopic techniques can be effective, but growing evidence shows that laparoscopic surgery offers significant advantages; it is safer, less invasive, and allows faster recovery but it needs expertise.

Open surgery remains important in complicated or emergency situations, but whenever feasible, laparoscopy should be the preferred approach. More large-scale studies are needed to establish recurrence rates and standard guidelines, but current case-based evidence strongly supports laparoscopic management.