Hepatodiaphragmatic interposition of the colon: anatomical findings of a variant of a Chilaiditi sign associated with a sliding hiatus hernia of the stomach

The present study contains a detailed anatomical description of a hepatodiaphragmatic interposition of the colon that corresponds to the signs of Chilaiditi and that has been found during routine dissection in the anatomical dissection course. The right colic flexure (hepatic flexure), the transverse colon and parts of the greater omentum were located in the left subphrenic recess. The hepatodiaphragmal interposition of the colon was associated with a sliding hiatus hernia of the stomach. A large portion of the stomach together with the corresponding section of the gastrocolic ligament was dislocated in the thoracic cavity.

In addition, postulated mechanisms in the etiology of the hepatodiaphragmatic interposition of the intestine were discussed, especially the malrotation and malfixation of the colon as predisposing factors for Chilaiditi signs. Whether there is a mechanical reason between the herniated stomach and the malrotated/malfixed colon remains to be resolved.