Gastric Perforation: A Case of Mis-Diagnosis as Chilaiditi Syndrome

Pneumoperitoneum is an essential sign for diagnosis of perforation in various radiological investigations. Immediate surgical exploration with definitive repair is life-saving. Chilaiditi syndrome is one such differential diagnosis which is transpositioning of a loop of large intestine in between the diaphragm and the liver, its incidence being 0.025% to 0.28%. A 47 year old male presented with pain over the Epigastrium and left hypochondrium since one day with no known co-morbidities. On examination, significant abdominal distension, diffuse guarding and tenderness over the left hypochrondrium and epigastric region. X-ray showed inter-position of bowel loops in between liver and diaphgram with CECT abdomen and pelvis showing a finding of Hollow viscus perforation with moderate ascites. Immediately Exploratory Laparotomy conducted. Patient recovered well post-operatively.