Abstract
Chilaiditi's sign is the presence of radiolucency in the subdiaphragmatic space as a result of colonic interposition, often misdiagnosed as a pneumoperitoneum. It is caused by anatomical variations that result in transpositioning of bowel within the subdiaphragmatic space. Chilaiditi's syndrome is the presentation of cardiac, respiratory or abdominal symptoms accompanied by Chilaiditi's sign. Symptomatic patients are managed with surgical intervention with the literature suggesting various resective and non-resective techniques to correct the anatomical defect. In this case an open right hemicolectomy was performed in attempt to remove the transpositioning bowel and a hepatopexy was performed to prevent any further reoccurrence of the syndrome. This case report highlights the diagnostic dilemma and management of Chilaiditi's syndrome in a resource constrained Sub-Saharan Hospital.