Fitz-Hugh-Curtis syndrome: a diagnosis to consider in women with right upper quadrant pain.

Abstract

ITZ-HUGH-CURTIS SYNDROME-perihepatitis associated with pelvic inflammatory disease-can pose a diagnostic challenge to the clinician, especially when right upper quadrant pain predominates, mimicking acute gall bladder disease. This article reviews the etiology, pathogenesis, diagnosis, and treatment of this syndrome. s HISTORICAL PERSPECTIVE Association with gonorrhea Fitz-Hugh-Curtis syndrome was first described in 1920 by Carlos Stajano, 1 who noted adhesions between the liver capsule and anterior abdominal wall in patients with gonococcal infection and right upper quadrant pain. In the 1930s Thomas Fitz-Hugh and Arthur Curtis also described the syndrome and made the connection between the acute clinical syndrome of right upper quadrant pain following a pelvic infection and the "violinstring" adhesions found in women with evidence of prior salpingitis. 2,3 Curtis described several cases of these very typical adhesions between the liver and the abdominal wall in patients with gonococcal disease and noted that similar adhesions were not found in other causes of peritonitis, suggesting the combination was a unique syndrome. 4 Fitz-Hugh suggested that Neisseria gonorrhoeae was the cause when he found gram-negative diplococci on smears from the liver capsule in patients with the syndrome. 2 Since then, the diagnosis of Fitz-Hugh-Curtis syndrome has largely been a clinical

Fitz-Hugh-Curtis syndrome: abdominal pain in women of 26 years old

“…Several typical ultrasonographic abnormalities in the perihepatic area related to the of Fitz-Hugh-Curtis syndrome have been described, such as fluid in the hepatorenal space and splenic hilum, loculated fluid in the abdomen and pelvis and anterior extrarenal space increased (2). The CT scan supports the diagnosis showing a contrast enhancement of the liver capsule (1,4,5). In the case of our patient this information was not present; however other tomographic and ultrasound findings such as perihepatic and perivesicular involvement and free left paraanexial fluid were objectified.…”

“…Fitz-Hugh-Curtis syndrome has been considered a gynecological disease, however the most common reason for consultation in the acute phase is right upper quadrant pain, therefore often attributed to the digestive tract during the first diagnostic approach (4).…”

Comparison between Fitz-Hugh-Curtis syndrome and uncomplicated pelvic inflammatory disease

“…그러나 위에서 언급한 것처럼 골반염의 특징을 보이지 않는 FHCS도 상당수 존재하여 실제 진료 환경에서 진단이 늦어지거나 적절한 치료 를 받지 못하는 경우를 종종 관찰할 수 있다. FHCS은 적절한 치료 없 이 진행된 경우 간 주위의 유착을 형성하여 만성적인 통증을 야기하거 나 연관된 골반염에 의한 불임, 골반 및 복강 내 유착 등의 합병증을 일 으킬 수 있어 [24], 빠른 진단이 중요하다고 할 수 있다.…”

Elderly Fitz-Hugh–Curtis syndrome observed with superb microvascular imaging system

“…Presently, the most common cause of FHCS is thought to be infection by chlamydia, the primary bacterium in cases of sexually transmitted infection [4]. More than 90% of cases of uterine cervicitis associated with chlamydia infection are asymptomatic, though when left untreated can lead to endometritis and pelviperitonitis, with the final result perihepatitis [5]. The most susceptible age for FHCS is approximately 20 years, though cases of elderly patients with FHCS caused by reactivation of chlamydia have been reported [6].…”