title: Intestinal interposition: the prevalence and clinical relevance of non-hepatodiaphragmatic conditions (non-Chilaiditi forms) documented by CT and review of the literature.
abstract: OBJECTIVE
  This study was done to assess the prevalence and clinical impact of non-hepatodiaphragmatic interpositions in a sample of adult patients undergoing computed tomography (CT) for a variety of medical reasons.
  
  
  METHODS
  From November 2008 to April 2009, two observers jointly examined the cases of intestinal interposition in 4,338 adults undergoing CT investigations. This study sought to identify not only hepatodiaphragmatic intestinal interpositions, defined as Chilaiditi, but also other forms of intestinal interposition, which we termed non-Chilaiditi. The latter were divided into five different classes on the basis of their anatomical relationships: splenorenal, retrogastric, hepatocaval, retrosplenic, and retrorenal. Moreover, a questionnaire investigating the clinical symptoms reported to be associated with Chilaiditi syndrome was given to patients exhibiting any form of intestinal interposition and to a control sample. Finally, clinical data related to the three groups were compared.
  
  
  RESULTS
  Of the 4,338 patients examined, 130 (3%) were found to have intestinal interposition, for a total of 143 forms: 90 Chilaiditi and 53 non-Chilaiditi. Of the latter, 30 were splenorenal, 12 retrogastric, five hepatocaval, four retrosplenic and two retrorenal. Statistical analysis showed that the Chilaiditi group suffered most symptoms (24.4%), followed by the non-Chilaiditi group (18.9%) and control cases (10.8%). Our results were validated using the χ(2) test of significance.
  
  
  CONCLUSIONS
  The number of non-Chilaiditi cases amounted to just over half the number of Chilaiditi cases, with the splenorenal form being by far the most frequent. Statistical analysis showed that patients with non-Chilaiditi forms of intestinal interposition had more symptoms than did controls.
authors.affiliation: School of Residency, Università degli Studi di Milano, Via di Rudinì 8, Milano, Italy. fabredolo@libero.it
authors.forename: F
authors.initials: F
authors.lastname: Bredolo
authors.forename: A
authors.initials: A
authors.lastname: Esposito
authors.forename: E
authors.initials: E
authors.lastname: Casiraghi
authors.forename: G
authors.initials: G
authors.lastname: Cornalba
authors.forename: P
authors.initials: P
authors.lastname: Biondetti
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003106:Colon / Q000002:abnormalities* / Q000000981:diagnostic imaging*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011860:Radiography, Abdominal; D014057:Tomography, X-Ray Computed