Introduction <p>This case report presents a rare instance of Chilaiditi’s syndrome caused by small bowel entrapment in perihepatic adhesion bands. Chilaiditi’s sign refers to the radiological appearance of bowel—typically colon—interposed between the liver and right hemidiaphragm, often mimicking pneumoperitoneum. When symptomatic, it is termed Chilaiditi’s syndrome, with abdominal pain, vomiting, and distension among common complaints. It has an incidence of 0.025–0.28%, predominantly affecting elderly males. Small bowel interposition causing Chilaiditi’s syndrome as in our patient is rare, making up 3–5% of all Chilaiditi’s syndrome cases.</p> Case Report <p>A 69-year-old man presented with a two-day history of epigastric pain, abdominal distension, and non-bloody, non-bilious vomiting. An initial abdominal X-ray suggested pneumoperitoneum, prompting further imaging. CT scan revealed dilated small bowel loops with a transition point in the right upper quadrant due to entrapment beneath the right hemidiaphragm, raising concern for closed-loop obstruction. Emergency laparotomy was performed, confirming internal herniation of small bowel into the right upper quadrant through two thick perihepatic adhesion bands. The affected bowel was viable and did not require resection. The adhesions were divided and bowel repositioned. The patient recovered uneventfully, being discharged on postoperative day five.</p> Conclusion <p>This case report demonstrates an unusual case of small bowel – rather than colonic, interposition under the right hemidiaphragm causing Chilaiditi’s syndrome, which is typically caused by colonic interposition. Moreover, it highlights the importance of timely evaluation via CT imaging as well as prompt surgical intervention, resulting in fewer complications, uneventful recovery and favourable outcomes.</p>