title: Chilaiditi's syndrome associated with colonic volvulus and intestinal malrotation-A rare case.
abstract: BACKGROUND
  Chilaiditi's syndrome (symptomatic hepatodiaphragmatic interposition of the colon) is an exceptionally rare cause of bowel obstruction and may present difficulty in diagnosis and management. This is the first reported case of colonic volvulus occurring in Chilaiditi's syndrome in association with intestinal malrotation and this case study describes its successful management.
  
  
  METHODS
  An 18 year old male presented as an emergency with vague abdominal pain and a past history of gastroschisis repair with intestinal malrotation. CT scanning showed a closed loop obstruction due to a volvulus of the colon herniating under the falciform ligament. The patient was successfully treated by surgical reduction of the hernia, anatomical correction of the malrotation and caecopexy with a tube caecostomy. At six month follow up the patient was well and asymptomatic.
  
  
  CONCLUSIONS
  In nine of the previously reported cases of Chilaiditi's syndrome with colonic volvulus, treatment was by partial colonic resection of which a third underwent stoma formation. One patient died as a consequence of anastomotic leak following primary anastomosis. We therefore suggest an alternative approach to management.
  
  
  CONCLUSIONS
  Chilaiditi's syndrome with colonic volvulus in association with intestinal malrotation has not previously been described. As there is no consensus in the literature as to how to manage such a case we suggest that reduction of the volvulus, anatomical correction of the malrotation and fixation of the caecum by tube caecostomy results in a successful outcome. This approach avoids the need for colonic resection and possible stoma formation.
authors.affiliation: Royal Glamorgan Hospital, Llantrisant, Rhondda Cynon Taf, Wales, CF72 8XR, United Kingdom.
authors.forename: A
authors.initials: A
authors.lastname: Williams
authors.affiliation: Royal Glamorgan Hospital, Llantrisant, Rhondda Cynon Taf, Wales, CF72 8XR, United Kingdom.
authors.forename: R
authors.initials: R
authors.lastname: Cox
authors.affiliation: Royal Glamorgan Hospital, Llantrisant, Rhondda Cynon Taf, Wales, CF72 8XR, United Kingdom.
authors.forename: B
authors.initials: B
authors.lastname: Palaniappan
authors.affiliation: Royal Glamorgan Hospital, Llantrisant, Rhondda Cynon Taf, Wales, CF72 8XR, United Kingdom. Electronic address: alan.woodward2@wales.nhs.uk.
authors.forename: A
authors.initials: A
authors.lastname: Woodward
keywords: Adult malrotation; Chilaiditi's syndrome; Colonic volvulus; Internal hernia; Nonrotation