Colonic hepato-diaphragmatic interposition, that occurs when the colon is located between the diaphragm and the liver, was described by Chilaiditi in 1910. Objective evidence of hepato-diaphragmatic interposition is referred to as Chilaiditi’s sign. Symptoms of hepato-diaphragmatic interposition (e.g., pain, nausea, vomiting, alteration of bowel habits) are subjective features of Chilaiditi’s syndrome. Hepato-diaphragmatic interposition can lead to intestinal obstruction, perforation, and ischemia. Chilaiditi’s syndrome also has led erroneously to the diagnoses of pneumoperitoneum, intra-abdominal abscess, and diaphragmatic hernia.