Fitz-Hugh-Curtis syndrome

Definition

• Fitz-Hugh-Curtis syndrome is a perihepatitis in the setting of pelvic inflammatory disease: inflammation of the liver capsule without involvement of the liver parenchyma, with adhesion formation and right upper quadrant pain.
• The syndrome is not exclusive to gonococcal infection and has been reported in both sexes.

Aetiopathogenesis

Aetiology

• It may result from acute gonococcal or chlamydial salpingitis; Chlamydia trachomatis is now considered the more common pathogen.
• In an emergency department study of 82 patients, Chlamydia trachomatis was detected by PCR in 89%, gonococci in only three patients.
• The pathogenesis is uncertain: proposed mechanisms are spread of exudate along the paracolic gutters from the pelvis to the diaphragm and haematogenous or lymphatic spread.

Clinical features

Late sequelae and perihepatitis

• Most important long-term sequelae: tubal sterility, ectopic pregnancy, chronic pain.
• Fitz-Hugh-Curtis syndrome: perihepatitis in chlamydial infection.
• Laparoscopically, this shows: violin string-like adhesions.

• The leading symptom is right upper quadrant pain that worsens with deep breathing and is attributed to capsular congestion and exudate.
• The upper abdominal pain may follow lower abdominal pain by a few days or occur simultaneously; it rarely occurs without lower abdominal pain.
• Fever and discharge may be absent: in that study only 15% had fever and 41% vaginal discharge.

Diagnosis

• The syndrome may mimic acute cholecystitis; it can usually be distinguished by evidence of salpingitis on pelvic examination or ultrasound.
• Dynamic CT including an arterial phase improves depiction of perihepatic capsular enhancement.
• The diagnosis is confirmed at laparoscopy or laparotomy by string-like adhesions (violin strings) between the liver surface and the anterior abdominal wall or by detecting the pathogen in hepatic capsular specimens.

Keep learning in the app

Further reading (selection)

1. Clinical features of Fitz-Hugh-Curtis Syndrome in the emergency department (Yonsei Med J 2012, PubMed Central)
2. StatPearls: Fitz-Hugh-Curtis Syndrome (NCBI Bookshelf)
3. MSD Manual Professional: Pelvic Inflammatory Disease (PID)
4. DocCheck Flexikon, Fitz-Hugh-Curtis-Syndrom

Cross-references