Introduction Chilaiditi syndrome is very seldom met in medical casuistry, having a frequency not more than 0.28% and it is described especially referring to people over 60 years old, mainly on males. Radiological diagnosis is represented by a loop of bowel interposition, frequently transverse colon in interhepato-diaphragmatic space.

Case presentation Patient CS, male, aged 16 years and 3 months with psychomotor retardation, is brought in emergency with abdominal pain, vomiting and faintness. On admission, the overall condition is serious, hypotonic, afebrile with toxic facies, subicteric skin, a distended abdomen with superficial vascularisation evident at thoracico-abdominal level. Laboratory examinations highlights acidosis, severe anaemic syndrome with anisocytosis and anizocromie, neutrophilic leukocytosis, hypoproteinemia, hepatic cytolysis, hyperammonemia and IgG positive for CMV and Toxoplasma. After the surgical clinical examination, it is practiced a gastric aspiration, rebalancing electrolyte, atibiotics, supportive treatment of liver function, eubiotic and neuropsychiatric treatment. Due to a marked flatulence, abdominal sonographic examination was irrelevant and radiological examination put in evidence the distension of intestinal loops overlaid over the whole hepatic area, with a pneumoperitoneum aspect. CT scan reveals hepatic left lobe aplasia, transverse colon interposition between right hepatic lobe and diaphragm and ascites throughout the abdominal cavity. The response to the instituted treatment for colonic decompression was favourable, with the disappearance of Chilaiditi sign, the improvement of liver function and of general health condition.

conclusions The particularity of this case seems to be the rare Chilaiditi syndrome associated with a previously undiagnosed mixed decompensated cirrhosis with liver left lobe aplasia at a teenager with psychomotor disabilities. We consider that the syndrome has been favoured by a decompensated cirrhosis.