Although it can be confused with a perforation, how can we describe the findings under the right hemi-diaphragm on the chest film?
This is Chiladiti sign or syndrome, where a gas-filled bowel loop is projected over the liver giving the appearance of gas under the diaphragm. However, there are bowel markings across this and the impression of thickening at the diaphragm so *no free gas*.
The main findings on the abdominal radiograph are hugely distended large bowel with a sigmoid loop taking up most of the abdominal space. Other distended large bowel loops adjacent and displaced to the patient's left flank.
The apex of this volvulus reaches the right hemidiaphragm in keeping with Chiladiti syndrome. No evidence of perforation.
Incidental fracture of right humeral neck, healed in poor position.