Abstract
Purpose
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.
Materials and 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 χ2 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.
Riassunto
Obiettivo
Scopo del nostro lavoro è stato valutare la prevalenza e l’impatto clinico delle forme di interposizione intestinale non epatodiaframmatiche in una popolazione adulta studiata con tomografia computerizzata (TC) per differenti indicazioni medico-chirurgiche.
Materiali e metodi
Da novembre 2008 ad aprile 2009, due autori hanno valutato insieme i casi di interposizione intestinale su 4338 pazienti adulti sottoposti a indagini TC. In tale studio, sono state evidenziate sia interposizioni di tipo epatodiaframmatico, che sono state definite Chilaiditi come da letteratura, sia altri tipi di interposizione definite secondo i diversi rapporti anatomici: splenorenale, retrogastrica, epatocavale, retrosplenica e retrorenale, che sono state raggruppate sotto il termine non-Chilaiditi. È stato successivamente sottoposto ai pazienti dei due gruppi e ad un gruppo controllo un questionario relativo ai disturbi clinici associati più frequentemente alla sindrome di Chilaiditi. Sono stati quindi comparati i dati clinici relativi ai tre gruppi.
Risultati
Su 4338 pazienti sono stati osservati 130 (3%) pazienti con interposizione colica per un totale di 143 manifestazioni, 90 Chilaiditi e 53 non-Chilaiditi: 30 interposizioni di tipo splenorenale, 12 di tipo retrogastrico, 5 epatocavale, 4 retrosplenico e 2 retrorenale. L’analisi statistica ha evidenziato che le forme di Chilaiditi producono una maggiore sintomatologia (24,4%), seguite dalle forme non-Chilaiditi (18,9%) e infine dai casi controllo (10,8%). Tale analisi è stata validata dal test di significatività χ2.
Conclusioni
Le forme non-Chilaiditi hanno rappresentato più della metà delle forme Chilaiditi, con la manifestazione splenorenale di gran lunga la più frequente. Abbiamo inoltre evidenziato che anche le forme non-Chilaiditi sono statisticamente più sintomatiche dei casi controllo.
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Bredolo, F., Esposito, A., Casiraghi, E. et al. Intestinal interposition: the prevalence and clinical relevance of non-hepatodiaphragmatic conditions (non-Chilaiditi forms) documented by CT and review of the literature. Radiol med 116, 607–619 (2011). https://doi.org/10.1007/s11547-011-0665-x
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DOI: https://doi.org/10.1007/s11547-011-0665-x