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• W4385232170 abstract "CASE REPORT A 20-year-old woman with a reported history of liver torsion and prior cholecystectomy was admitted with complaints of decreased appetite and jaundice. Laboratory workup revealed total bilirubin 7.8 mg/dL (ref: 0.1–0.2 mg/dL) with direct bilirubin 6.4 mg/dL (ref: <0.3 mg/dL), aspartate aminotransferase 42 U/L (ref: 8–33 U/L), alanine aminotransferase 95 U/L (ref: 4–36 U/L), and alkaline phosphatase 495 IU/L (ref: 44–147 IU/L). An abdominal MRI revealed an extrinsic, waist-like compression on the right hepatic lobe, biliary tree, and intrahepatic portal vasculature, from the ascending colon and adjacent mesentery with upstream biliary dilatation and hepatic vascular congestion (Figure 1). Consequently, the cause of biliary obstruction was attributed to Chilaiditi syndrome (CS). Conservative management was initiated with intravenous hydration, bowel decompression, and an aggressive bowel regimen. The patient improved clinically and eventually had a bowel movement after 24 hours of treatment initiation. This coincided with a downward trend in liver biochemistries, and she was discharged home. A follow-up appointment 2 months later showed normalized liver biochemistries with good bowel function.Figure 1.: (A) Coronal FIESTA imaging shows the omentum and colon draped over the superior liver with extrinsic bile duct compression (blue arrow) and dilation (yellow arrow). (B) Coronal T2 imaging shows circumferential encasement of the central liver and bile ducts from the extrinsic omentum and portions of the colon (blue arrows). (C) Axial T2 imaging shows portions of the colon extending over the superior aspect of the liver (blue arrow) resulting in external compression. (D) Axial T2 imaging shows dilated bile ducts (yellow arrow) resulting from extrinsic compression from the colon and adjacent omentum (blue arrow).CS entails the symptomatic presentation secondary to interposition of a bowel loop in the hepatodiaphragmatic space.1 This can often be misinterpreted as pneumoperitoneum and subsequently lead to unwarranted emergent surgical interventions. Management of CS rests largely on conservative measures including intravenous hydration, bowel decompression, and cleansing2,3 while surgery is reserved for refractory/recurrent or complicated cases. Potential complications include intestinal obstruction, bowel perforation or ischemia, colonic volvulus, and subphrenic appendicitis.1 To the best of our knowledge, this is the first case of CS manifesting as obstructive jaundice, with a unique finding of relative portobiliary obstruction due to the malpositioned bowel. It highlights the importance of avoiding invasive measures as even serious physiologic insults posed by portobiliary obstruction may improve with conservative therapy. DISCLOSURES Author contributions: JS Pannu wrote and revised the manuscript. JS Kosirog had direct involvement with clinical care of the patient and wrote and revised the manuscript. WM Tierney revised the manuscript. CA Lawrence Jr was responsible for finalizing the radiological images and revised the manuscript. JS Pannu is the article guarantor. Financial disclosure: None to report. Informed consent: All attempts have been exhausted in trying to contact the patient, next of kin, and/or parent/guardian for informed consent to publish their information, but consent could not be obtained." @default.
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• W4385232170 date "2023-07-01" @default.
• W4385232170 modified "2023-10-12" @default.
• W4385232170 title "Biliary Obstruction Secondary to Chilaiditi Syndrome" @default.
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• W4385232170 doi "https://doi.org/10.14309/crj.0000000000001109" @default.
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