Fitz-Hugh-Curtis Syndrome: perihepatitis and sepsis in puerperium

Abstract

Nonoperative management is currently the preferred treatment for trauma to the liver and spleen in hemodynamically stable patients. Angiography and embolization are an important adjunct to prevent the need for surgery or to postpone the need for surgery to a later and more elective stage, which leads to a better outcome for the patient.Imaging work-up is essential in splenic and liver trauma and indications for angiography and embolization are determined by a combination of clinical and imaging findings, with “contrast blush” at contrast-enhanced computed tomography being the most important imaging feature.Other imaging features indicating the need for angiography and embolization are false aneurysm, vascular cut-offs, and arteriovenous fistulas because these are associated with an increased risk for delayed hemorrhage.The aim of angiography and embolization in trauma of the liver and spleen is to stop ongoing bleeding or to prevent delayed bleeding, thereby making nonoperative management safer.The most commonly used embolic agents for liver and splenic trauma are 0.035-inch coils or microcoils, but in certain instances embolization plugs, Gelfoam, or particles can be used.Embolization for liver injury is preferably performed as selectively as possible. When proximal or central embolization is performed, the so-called front- and backdoor technique should be used. When there is diffuse bleeding, e.g., when there is a ruptured massive subcapsular hematoma, embolization with particles or Gelfoam from a relatively unselective position may be required.Embolization for splenic injury may be performed by occluding the proximal splenic artery, which leads to a decrease in perfusion pressure of the spleen or by performing distal or selective embolization as close to the bleeding location as possible. Both techniques are equivalent in terms of outcome but have somewhat different areas of application.Embolization of hepatic and splenic injury has a >90% technical and >80% clinical success rate with an acceptable number of complications. Complications include all common systemic and angiography complications as well as specific complications such as liver abscess and splenic infarcts and/or abscess.