Free air or colon?

Authors: Iyer, Shridar G; Leow, CK

Source: Surgical Practice, Volume 7, Number 4, November 2003 , pp. 136-138(3)

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Abstract:

Background:

Subphrenic abscess can present with respiratory symptoms with minimal or no abdominal signs. The air/fluid level seen on chest X-ray can be misinterpreted as that within a loop of intestine (Chilaiditi's sign) thus leading to delayed diagnosis. Methods:

Case report. Results:

An 83-year-old female presented with respiratory symptoms. Chest X-ray showed an air/fluid level under the right hemi-diaphragm. This was initially interpreted as Chilaiditi's sign. The subphrenic abscess was confirmed by a computed tomography scan. At laparotomy, the abscess was communicating with a perforation in the fundus of the gall bladder. In addition, there was a fistula connecting the neck of the gall bladder and the second part of the duodenum. The abscess was drained and the fistula tract disconnected. Post-operatively the patient had an uneventful recovery. Conclusion:

Patients with subphrenic abscess can present with symptoms mimicking a respiratory infection. The air/fluid level seen on chest X-ray can be misinterpreted as Chilaiditi's sign. Most subphrenic abscesses occur secondarily to an underlying pathology within the gastrointestinal tract. A thorough search for an underlying intra-abdominal pathology must be made.

Keywords: Chilaiditi's syndrome; subphrenic abscess

Document Type: Case report

DOI: http://dx.doi.org/10.1046/j.1442-2034.2003.00182.x

Affiliations: 1: Department of Surgery, National University Hospital, 5 Lower Kent Ridge Road, Singapore 119074, Singapore.

Publication date: 2003-11-01