{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,23]],"date-time":"2026-07-23T17:12:00Z","timestamp":1784826720371,"version":"3.55.0"},"reference-count":15,"publisher":"BMJ","issue":"7","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Case Rep"],"accepted":{"date-parts":[[2026,7,5]]},"published-print":{"date-parts":[[2026,7]]},"abstract":"<jats:p>\n                    Chilaiditi syndrome is a rare condition, reported in 0.025%\u20130.28% of the population, in which bowel interposition between the liver and the right hemidiaphragm becomes symptomatic. A male patient in his 60s with hypertension, hypothyroidism, ischaemic cardiomyopathy, chronic kidney disease and a 40-pack-year smoking history presented with progressive abdominal distension, nausea and vomiting for 3\u2009days. He underwent urgent laparotomy with repair of a proximal jejunal perforation. After tracheal intubation, peak airway pressure increased to 50 cmH\n                    <jats:sub>2<\/jats:sub>\n                    O. Lung-protective ventilation with low tidal volumes, permissive hypercapnia, head-up positioning and nasogastric decompression improved compliance and reduced airway pressures to 36 cmH\n                    <jats:sub>\u2082<\/jats:sub>\n                    O. In the intensive care unit (ICU), staged ventilatory adjustments facilitated gradual weaning to bilevel positive airway pressure (BiPAP) by postoperative day 3. This case shows how Chilaiditi syndrome, complicated by bowel obstruction, can impair respiratory mechanics and create major intraoperative ventilatory challenges. Careful airway pressure interpretation and planned postoperative ventilatory support were central to safe management.\n                  <\/jats:p>","DOI":"10.1136\/bcr-2026-272491","type":"journal-article","created":{"date-parts":[[2026,7,23]],"date-time":"2026-07-23T16:45:26Z","timestamp":1784825126000},"page":"e272491","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Anaesthesia management of a patient with Chilaiditi syndrome: perioperative mechanical ventilation challenges"],"prefix":"10.1136","volume":"19","author":[{"ORCID":"https:\/\/orcid.org\/0009-0006-1146-0864","authenticated-orcid":false,"given":"Zoha","family":"Asghar","sequence":"first","affiliation":[{"name":"Medical College, The Aga Khan University Medical College, Karachi, Pakistan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9327-1015","authenticated-orcid":false,"given":"Waleed Bin","family":"Ghaffar","sequence":"additional","affiliation":[{"name":"Department of Anaesthesia, The Aga Khan University Hospital, Karachi, Pakistan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chander","family":"Kala","sequence":"additional","affiliation":[{"name":"Our Lady of Lourdes Hospital, Drogheda, Ireland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Saima","family":"Rashid","sequence":"additional","affiliation":[{"name":"Department of Anaesthesia, The Aga Khan University Hospital, Karachi, Pakistan"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2026,7,23]]},"reference":[{"key":"2026072309451887000_19.7.e272491.1","unstructured":"Kumar A , Syndrome MDC . StatPearls. Treasure Island (FL): StatPearls Publishing, 2026."},{"key":"2026072309451887000_19.7.e272491.2","doi-asserted-by":"crossref","first-page":"270","DOI":"10.26502\/jsr.10020134","article-title":"Management of Chilaiditi syndrome: Our Experience and Literature Review","volume":"04","author":"Michele","year":"2021","journal-title":"J Surg Res"},{"key":"2026072309451887000_19.7.e272491.3","unstructured":"Schick MA , Kashyap S , Collier SA , et al . Small bowel obstruction. In: StatPearls. Treasure Island, 2026."},{"key":"2026072309451887000_19.7.e272491.4","unstructured":"Sharma SM . Undiagnosed subclinical hypothyroidism associated with Chilaiditi\u2019s syndrome affecting anesthetic management. Anaesth Pain Intensive Care 2019;118\u20139."},{"key":"2026072309451887000_19.7.e272491.5","doi-asserted-by":"crossref","first-page":"574","DOI":"10.1016\/j.jemermed.2019.07.014","article-title":"The Chicken or the Egg - Chilaiditi and Constipation","volume":"57","author":"Hussain","year":"2019","journal-title":"J Emerg Med"},{"key":"2026072309451887000_19.7.e272491.6","doi-asserted-by":"crossref","first-page":"171","DOI":"10.1177\/0976500X241246412","article-title":"Perioperative Cardiopulmonary Complications in Smokers and Non-smokers Undergoing Elective Surgery: A Prospective Study","volume":"15","author":"Reddy","year":"2024","journal-title":"J Pharmacol Pharmacother"},{"key":"2026072309451887000_19.7.e272491.7","unstructured":"Hickey SM , Sankari A , Giwa AO . Mechanical ventilation. In: StatPearls. Treasure Island (FL), 2026."},{"key":"2026072309451887000_19.7.e272491.8","doi-asserted-by":"crossref","first-page":"320","DOI":"10.5114\/ait.2022.120673","article-title":"Interpretation and use of intraoperative protective ventilation parameters: a scoping review","volume":"54","author":"Placenti","year":"2022","journal-title":"Anaesthesiol Intensive Ther"},{"key":"2026072309451887000_19.7.e272491.9","doi-asserted-by":"crossref","DOI":"10.1155\/2022\/2635616","article-title":"Hypercapnia from Physiology to Practice","volume":"2022","author":"Almanza-Hurtado","year":"2022","journal-title":"Int J Clin Pract"},{"key":"2026072309451887000_19.7.e272491.10","doi-asserted-by":"crossref","DOI":"10.1186\/s13613-019-0522-y","article-title":"Ventilation in patients with intra-abdominal hypertension: what every critical care physician needs to know","volume":"9","author":"Regli","year":"2019","journal-title":"Ann Intensive Care"},{"key":"2026072309451887000_19.7.e272491.11","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2019.7505"},{"key":"2026072309451887000_19.7.e272491.12","doi-asserted-by":"publisher","DOI":"10.1148\/radiol.2462070712"},{"key":"2026072309451887000_19.7.e272491.13","doi-asserted-by":"crossref","DOI":"10.3389\/fphys.2022.1005698","article-title":"Chest CT scan for the screening of air anomalies at risk of pulmonary barotrauma for the initial medical assessment of fitness to dive in a military population","volume":"13","author":"Bonnemaison","year":"2022","journal-title":"Front Physiol"},{"key":"2026072309451887000_19.7.e272491.14","article-title":"Thoracic Gut Entrapment Presenting As Intractable Hypoxia: A Case Report of Chilaiditi Syndrome","volume":"14","author":"Asanad","year":"2022","journal-title":"Cureus"},{"key":"2026072309451887000_19.7.e272491.15","article-title":"Intensive Care Management of an Adult Patient With Rare Chilaiditi Syndrome Presenting as Abdominal Breathing: A Case Report","volume":"16","author":"Yilmaz","year":"2024","journal-title":"Cureus"}],"container-title":["BMJ Case Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bcr-2026-272491","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,7,23]],"date-time":"2026-07-23T16:45:27Z","timestamp":1784825127000},"score":1,"resource":{"primary":{"URL":"https:\/\/casereports.bmj.com\/lookup\/doi\/10.1136\/bcr-2026-272491"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,7]]},"references-count":15,"journal-issue":{"issue":"7","published-online":{"date-parts":[[2026,7,23]]},"published-print":{"date-parts":[[2026,7]]}},"alternative-id":["10.1136\/bcr-2026-272491"],"URL":"https:\/\/doi.org\/10.1136\/bcr-2026-272491","relation":{},"ISSN":["1757-790X"],"issn-type":[{"value":"1757-790X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,7]]}}}