Clinical outcome of Fitz-Hugh-Curtis syndrome mimicking acute biliary disease

Abstract

AIM:To analyze the clinical characteristics of patients diagnosed with Fitz-Hugh-Curtis syndrome. METHODS:The clinical courses of patients that visited St. Mary's Hospital with abdominal pain from January 2005 to December 2006 and were diagnosed with Fitz-Hugh-Curtis syndrome were examined. RESULTS: Fitz-Hugh-Curtis syndrome was identified in 22 female patients of childbearing age; their mean age was 31.0 ± 8.1 years. Fourteen of these cases presented with pain in the upper right abdomen alone or together with pain in the lower abdomen, and six patients presented with pain only in the lower abdomen. The first impression at the time of visit was acute cholecystitis or cholangitis in 10 patients and acute appendicitis or pelvic inflammatory disease in eight patients. Twenty-one patients were diagnosed by abdominal computer tomography (CT), and the results of abdominal sonography were normal for 10 of these patients. Chlamydia trichomatis was isolated from 18 patients. Two patients underwent laparoscopic adhesiotomy and 20 patients were completely cured by antibiotic treatment. CONCLUSION:For women of childbearing age with acute pain in the upper right abdomen alone or together with pain in the lower abdomen, Fitz-HughCurtis syndrome should be considered during differential diagnosis. Moreover, in cases suspected to be Fitz-HughCurtis syndrome, abdominal CT, rather than abdominal sonography, assists in the diagnosis.

Fitz-Hugh–Curtis syndrome

“…The diagnostic standard was abdominal CT scan that showed pelvic inflammation with contrast enhancement of hepatic capsules and adhesions between the liver and the diaphragm or the liver and the abdominal wall detected by laparoscopy. Twenty out of 22 patients visited the emergency room due to acute abdominal pain, 32% of which was spotted in the right upper abdomen, 32% both in the right upper abdomen and in the lower abdomen, 27% only in the lower abdomen, while 4.5% presented with fever and 4.5% with epigastric pain [11].…”

“…Fitz-Hugh-Curtis syndrome is more common in women of reproductive age who visit hospitals due to acute pain and tenderness in the right upper abdomen [11]. This pain is caused by adhesion of the anterior hepatic surface and the abdominal wall [12].…”

Fitz-Hugh–Curtis syndrome in a 16-year-old female due to Ureaplasma urealyticum

“…Woo et al [1] in 2008 reported one out of the 22 female FHCS patients to be positive for U. urealyticum. So far, our patient is the second incidence worldwide to associate U. urealyticum with FHCS.…”

“…Up to date, FHCS is mainly attributed to Neisseria gonorrhoeae and Chlamydia trachomatis infection while the role of other microorganisms is yet unknown [1]. Definite diagnosis of FHCS is made by assessment of perihepatic adhesions via diagnostic laparoscopy and both conventional microbiological methods and nucleic acid amplification techniques are used to isolate the responsible organism [2].…”

Right Upper Quadrant Pain in a Young Female

“…The FHC syndrome typically presents without or only faint involvement of the liver parenchyma. While Neisseria gonorrhoeae was the first established pathogen [1,2], Chlamydia trachomatis is incriminated in most cases nowadays [3]. The pathophysiology of perihepatitis FHC is unclear, but direct infection of the liver capsule, hematologic or lymphatic spread as well as an exaggerated immune response have been suggested [4].…”