Fitz-Hugh-Curtis Research Articles

Gonococcal peritonitis: A case report and review of literature.

Neisseria gonorrhoeae (Ng) is a major cause of morbidity among sexually active individuals, occasionally leading to serious complications if left untreated. We describe a case of gonococcal peritonitis as a rare complication of Ng infection in a woman presenting with acute abdomen and intestinal subacute occlusion. Due to the rarity of this clinical presentation, we review the scientific literature to identify best practices and inform guidelines.

Imaging of Perisplenitis as an Unusual Presentation of the Fitz-hugh-curtis Syndrome

Objective − We present the imaging characteristics of an unusual case of Fitz-Hugh-Curtis syndrome (FHCS), a late complication of pelvic inflammatory disease in an adolescent girl with left upper abdominal pain due to perisplenitis seen on contrast-enhanced ultrasound and magnetic resonance imaging.Case Report − A 16-year-old girl presented with acute abdominal pain in the left upper quadrant, vomiting, diarrhoea, and vaginal odour with yellow discharge. She was recently diagnosed with infectious mononucleosis. Abdominal ultrasound showed perisplenic fluid collection that did not enhance post-contrast application, but it did show a mild enhancement of perisplenic tissue. MRI findings indicated perisplenitis. The results of the positive vaginal swab for Chlamydia trachomatis and Ureaplasma parvum and the imaging findings favoured a final diagnosis of FHCS with perisplenitis.Conclusion − Imaging findings, and clinical and laboratory data, including positive vaginal swabs, are crucial to confirm the unusual presentation of FHCS in an adolescent with left upper abdominal pain.

Fitz-Hugh-Curtis Syndrome: A Case Report Emphasizing Timely Recognition and Management in Pelvic Inflammatory Disease

Fitz-Hugh-Curtis syndrome (FHCS) is a rare complication of pelvic inflammatory disease (PID), that presents with right upper quadrant abdominal pain, often mimicking hepatic, or biliary conditions. Timely diagnosis is crucial to prevent complications. This case report represents 34 years old female came to ER complaining from right upper quadrant abdominal pain and nausea for one month.

Intrahepatic Gallbladder Associated with Fitz-HughCurtis Syndrome: A Case Report

Intrahepatic Gallbladder Associated with Fitz-HughCurtis Syndrome: A Case Report

Acute Cholecystitis VS Fitz-Hugh-Curtis Syndrome: A Case Report and Literature Review

A young married lady presented with right upper quadrant pain and after clinical assessment and investigations she was diagnosed with calculus cholecystitis. An elective laparoscopic cholecystectomy was planned, but on getting the entry in the peritoneal cavity an interesting view was encountered. There were dense adhesions in the right upper abdomen, liver adherent to the abdominal wall and a normal looking gallbladder with bluish hue and few tiny intraluminal stones. There was peri-hepatitis with bilateral inflamed fallopian tubes. The patient was diagnosed with Fitz-Hugh-Curtis syndrome (FHCS), a complication of pelvic inflammatory disease. Treatment is hence directed towards the underlying cause. FHCS is a diagnosis of exclusion and confirmed on laparoscopic exploration. Cervical swabs and samples of fluid taken from the peritoneum and liver surface can aid in diagnosis. The most common organisms are Chlamydia trachomatis and Neisseria gonorrhoeae. Although most of the patients are young women, there are case reports of this entity in men as well. Management is to treat the underlying PID. Laparoscopic release of peri-hepatic bands may aid in pain relief. Complications include sepsis, infertility, and adhesive bowel disease. This may not be a common disease, but it can leave permanent scars. The underlying PID should be treated urgently to minimize the collateral damage. Education and couple therapy is important as prevention is the best treatment.

Fitz–Hugh–Curtis Syndrome

Fitz–Hugh–Curtis Syndrome

952 When A Surgeon Was Called to The Obstetric Unit: A Rare Case of Gonococcal Peritonitis in A 12-Week Pregnancy

Abstract Background Primary bacterial peritonitis presenting as septic shock is infrequently seen in clinical practice. This is a case of gonococcal peritonitis presenting as septic shock in a pregnant lady needing emergency laparotomy, drainage of purulent fluid and abdominal lavage. Case Presentation A 35-year-old woman presented with severe generalised abdominal pain. No history of fever, vomiting, urinary or bowel complaints. She was in her 4th pregnancy, at 12-weeks gestation. She was afebrile but tachycardic and hypotensive. Abdomen was tender and there was no vaginal bleeding. Ultrasound scan showed minimal fluid in hepatorenal area and a viable intrauterine pregnancy. Differential diagnosis were ruptured appendix, ectopic pregnancy, acute abdomen and shock. Exploratory laparotomy was done. Moderate amount of purulent fluid was noted within the abdominal cavity and no bleeding was seen. General surgeon was called for assistance by the Obstetrician as no foci of infection was found. The uterus, fallopian tubes, ovaries, appendix, bowel and upper abdominal organs were found to be intact. Peritoneal fluid culture was taken. Drainage of purulent fluid and peritoneal wash was done. She was nursed in ICU because of peritonitis with septic shock and AKI. Peritoneal fluid culture showed Neisseria gonorrhoea and IV ceftriaxone was given for 7 days. Postoperatively she recovered well but needed evacuation of uterus for a missed miscarriage. She was screened for other STIs and were negative. Discussion Gonorrhoea is the second most common reported STI. It can present as acute peritonitis when the infection has spread beyond upper reproductive tract organs.

Gonococcal pelviperitonitis: a diagnostic challenge

Neisseria gonorrhoeae is the second most common etiological agent of pelvic inflammatory disease and is currently un-derdiagnosed due to its asymptomatic presentation in 50% of cases. When the disease presents, it may appear in the form of acute abdomen and normal imaging tests, making it a major diagnostic challenge. We present four cases of acute gonococcal peritonitis. The main symptom was acute abdominal pain, and both the gy-necological examination and complementary tests showed normal results. The only notable finding from the laparoscopy was the existence of purulent ascitic fluid. The results of the anatomical and pathological tests were all normal. Endocer-vical and ascitic fluid culture showed infection with N. gonorrhoeae, and in one case, concomitant infection with Chlamydia trachomatis. The definitive treatment applied was intravenous antibiotic therapy. When a sexually active young woman is diagnosed with peritonitis that has no apparent cause, it is important to rule out sexually transmitted diseases.

Fitz-Hugh Curtis Syndrome: an Incidental Finding During Infertility Workup

Fitz-Hugh-Curtis syndrome (FCHS), also known as acute perihepatitis, is a rare disorder characterised by inflammation of the peritoneum and the tissues surrounding the liver. This syndrome can arise as a potential complication from a pelvic inflammatory disease caused by Neisseria gonorrhoeae or Chlamydia trachomatis. This is a case of 26 years’ healthy asymptomatic woman with primary infertility where this syndrome was diagnosed incidentally during laproscopy.

A Rare Case of Chlamydia Trachomatis Associated Fitz-Hugh-Curtis Syndrome Masquerading Acute Cholecystitis

Fitz-Hugh–Curtis syndrome (FHCS) isa rare complication of pelvic inflammatory disease (PID) characterized by inflammation of the liver capsule (perihepatitis) following the spread of a pelvic starting point infection leading to the creation of adhesions. The most commonly involved germ is Chlamydia trachomatis. The condition is named after the two physicians, Thomas Fitz-Hugh, Jr and Arthur Hale Curtis who first reported this condition in 1934 and 1930 respectively. The clinical presentation can be misleading and simulate cholecystitis or other cause of pain in the right hypochondrium. In imaging, it results in a contrast enhancement characteristic of the hepatic capsule at portal time.

Fitz-Hugh-Curtis syndrome revealed by a suspected cholecystitis: A case report

Fitz-Hugh–Curtis syndrome is characterized by inflammation of the liver capsule following the spread of a pelvic starting point infection. The most commonly involved germ is Chlamydia trachomatis. The clinical presentation can be misleading and simulate cholecystitis or other cause of pain in the right hypochondrium. In imaging, it results in a contrast enhancement characteristic of the hepatic capsule at portal time.

2324 Right Upper Quadrant Pain in a Young Woman Isn't Always Biliary in Origin: A Case of Fitz-Hugh–Curtis Syndrome (FHCS)

INTRODUCTION: Fitz-Hugh–Curtis syndrome (FHCS) is a rare complication of pelvic inflammatory disease (PID) causing inflammation of the liver capsule and peri-hepatic peritoneal surfaces. It usually is caused by Neisseria gonorrhoeae or Chlamydia trachomatis ascending from genital tract infections. Here we present a case of right upper quadrant (RUQ) abdominal pain initially thought to be biliary in origin, with the etiology ultimately thought to be FHCS. CASE DESCRIPTION/METHODS: A 24-year-old woman with no significant past medical history presented to the emergency department with RUQ abdominal pain for one week. The pain was described as sharp, constant, “pinching and pulling” in quality, worsened by coughing and deep breathing, and associated with nausea and vomiting. While she reported being sexually active, there were no genital or urinary symptoms or any history of sexually transmitted infections. Physical examination was notable for RUQ tenderness with positive Murphy’s sign. Pelvic exam was negative for cervical motion tenderness (CMT), adnexal or uterine tenderness, cervical or vaginal discharge. Labs were significant only for leukocytosis of 13.5 K/uL and an elevated total bilirubin to 1.7 mg/dL, both of which resolved within 24 hours. Abdominal ultrasound and magnetic resonance cholangiopancreatography showed no evidence of cholecystitis or gallstones. Given persistent symptoms despite improving blood work and unremarkable imaging, the leading concern was biliary colic or sludge. Diagnostic laparoscopy was performed, showing an injected peri-hepatic diaphragmatic peritoneum and focal adhesions between the liver capsule and anterior abdominal wall, suggesting FHCS. Of note, all gynecologic organs were inspected and appeared normal. Gallbladder was removed during the procedure as a precaution, and pain resolved shortly after surgery. Nucleic acid amplification test for Chlamydia trachomatis ultimately was positive, confirming the diagnosis of FHCS. DISCUSSION: FHCS usually presents with RUQ abdominal pain that mimics hepatobiliary etiologies, and usually is associated with symptoms of PID including pelvic/lower abdominal pain, vaginal discharge or CMT. This case of FHCS is atypical in that the patient presented only with RUQ pain in the absence of PID symptoms, which may be due to bacteria bypassing pelvic structures on the way to the liver capsule. FHCS should be considered in the differential diagnosis of RUQ abdominal pain in young women of reproductive age.

A Forgotten Cause of Acute Abdominal Pain

Fitz-Hugh-Curtis syndrome (FHCS) is a rare complication of pelvic inflammatory disease (PID) that involves liver capsule inflammation, leading to creation of adhesions. It occurs most commonly in women of childbearing age. However, it has been reported in men. An 18-y.o. G1P1 female presented to the ER with one week history of severe intermittent RUQ pain, radiating to her right shoulder; each pain episode lasting about 30 minutes. On day of admission, her pain lasted for 5 hours, with no other GI or GU symptoms. She was vitally stable and her exam was unremarkable except for mild RUQ tenderness. Urine pregnancy test, US, and CT abdomen with IV contrast were negative. She was put on supportive therapy with pain medications but continued to have severe pain and repeat CT abdomen was negative. On detailed history, she reported unprotected coitus. PCR for Gonorrhea and Chlamydia later came back positive. Gynecological evaluation revealed normal uterus, cervix without motion tenderness, and non-tender adnexa. She was started on antibiotics but continued to have excruciating pain. Diagnostic laparoscopy was therefore performed showing turbid pelvic fluid, bilateral injected fallopian tubes both adherent to the sigmoid colon, appendix adherent to the right fallopian tube, right liver lobe surface with hemorrhagic exudates mirroring the overlying peritoneal surface, normal ovaries, uterus and gallbladder. Adhesions were lysed. The findings were consistent with acute PID with FHCS. Intra-abdominal cultures remained negative. She improved clinically and was discharged to complete a course of oral antibiotics. FHCS is a type of perihepatitis that causes liver capsule inflammation without affecting hepatic parenchyma. FHCS consists of RUQ pain following transabdominal spread of infection from PID. During the chronic phase, adhesions form between the anterior liver capsule and the anterior abdominal wall or diaphragm, classically described as ‘violin strings'. FHCS provides a diagnostic challenge as it can mimic many other diseases, most often acute cholecystitis. Non-invasive diagnostic modalities are usually non-revealing, and diagnostic laparoscopy for direct visualization is often required. Therefore, a high index of clinical suspicion is needed to avoid delay in treatment initiation and increased morbidity. Clinicians should be made aware that FHCS cannot be excluded when patients present with RUQ abdominal pain without significant signs of biliary tract disease.

Fitz-Hugh-Curtis syndrome associated with tuberculous salpingitis and peritonitis: a case presentation and review of literature

BackgroundFitz-Hugh-Curtis syndrome or acute perihepatitis is considered a rare complication of pelvic inflammatory disease, mostly associated with chlamydial or gonococcal salpingitis.Peritoneal tuberculosis is a rare site of extra-pulmonary infection caused by Mycobacterium tuberculosis. Infection usually occurs after reactivation of latent tuberculous foci in the peritoneum and more seldom after contiguous spread from tuberculous salpingitis.Case presentationWe describe a case of a 21-year old female of Somalian origin diagnosed with Fitz-Hugh Curtis syndrome associated with tuberculous salpingitis and peritonitis, presenting with new onset ascites.Acid fast stained smear and polymerase chain reaction for Mycobacterium tuberculosis on ascitic fluid, endocervical culture and tuberculin skin test were all negative. Eventually, the diagnosis was made laparoscopically, showing multiple peritoneal white nodules and perihepatic “violin string” fibrinous strands.ConclusionsTo our knowledge, this is the first case where Fitz-Hugh-Curtis syndrome is associated with both peritoneal and genital tuberculosis and where ascites was the primary clinical finding. Female genital tuberculosis has only rarely been associated with Fitz-Hugh-Curtis syndrome and all cases presented with chronic abdominal pain and/or infertility. Ascites and peritoneal involvement was not present in any case. Moreover, most patients with Fitz-Hugh-Curtis syndrome show no evidence of generalized intra-abdominal infection and only occasionally have concomitant ascites.

Elderly Fitz-Hugh\u2013Curtis syndrome observed with superb microvascular imaging system

Fitz-Hugh–Curtis syndrome (FHCS) is defined as inflammation on the surface of the liver following sexually transmitted chlamydia infection. We successfully observed the microvascular structure of the inflamed portion between the abdominal wall and surface of the liver in an elderly patient with FHCS using a superb microvascular imaging (SMI) system, a new technology developed for observing minute vascular flow. An 80-year-old Japanese female with right dorsal to lateral abdominal pain and fever came to our hospital. Anti-chlamydia antibodies were positive. SMI revealed signals suggesting small vessels passing from the liver surface to the hypoechoic space.

Fitz-Hugh-Curtis Syndrome Preceded by Constipation in a 14-Year-Old Girl

Fitz-Hugh-Curtis syndrome (FHCS) is uncommon in children that pediatricians hardly list in the differential diagnosis of abdominal pain. A 14-year-old girl developed intermittent lower abdominal pain accompanied by constipation. She presented with subsequent right upper quadrant abdominal tenderness. With a medical interview of her sexual activity, FHCS was suspected and confirmed by a plain computed tomography, Gadolinium-enhanced magnetic resonance imaging and a detection of Chlamydia trachomatis in her vaginal discharge. She responded well to standard antimicrobial treatment and constipation was resolved simultaneously. Constipation is a most common cause of abdominal pain in children. However, FHCS should be considered in a potentially sexually active girl with an accompanied right upper quadrant abdominal pain.

Complicated Lymphogranuloma Venereum With Pelvic Peritonitis in Young Man

Abstract Chlamydia trachomatis–linked pelvic peritonitis occurs mainly in young women of childbearing age, most often in a context of salpingitis. Fitz-Hugh–Curtis syndrome and perihepatitis have been reported in only 2 men with acquired immunodeficiency syndrome. We present here the observation of these patients including clinical presentation, morphological examinations, and therapeutic decision with follow-up. No surgery was performed. Antibiotic therapy was successfully introduced. Chlamydia trachomatis–linked pelvic peritonitis rarely occurs in men and is often associated to immunodeficiency. Diagnosis must be evoqued in medical peritonitis with no etiology found when patient's anamnesis tends to suspect an important sexually transmitted disease risk.

Fitz-Hugh-Curtis syndrome.

Fitz-Hugh-Curtis syndrome.

The Fitz Hugh-Curtis Syndrome and Hydrosalpinx: Analysis of Findings in Gynecologic Laparoscopy Procedure of Infertile Women

Method: the study was conducted to analyze the correlation between Fitz Hugh-Curtis syndrome (FHCS) with the occurrence of hydrosalpinx, and the risk for hydrosalpinx occurrence due to FHCS. This observational retrospective study was conducted by reviewi...

Fitz-Hugh-Curtis症候群に特徴的とされる肝表面癒着を認めたMayer-Rokitansky-Küster-Hauser症候群の一例

Background: Fitz-Hugh-Curtis syndrome (FHCS) is a condition of perihepatitis associated with gonococcal or chlamydial infection, characterized by perihepatic adhesions between the liver capsule and the diaphragm or the anterior peritoneal surface. The possibility of women with Mayer-Rokitansky-Küster-Hauser syndrome (MRKHS) experiencing sexually transmitted diseases is very low. We report a rare case where a woman with MRKHS was detected with perihepatic adhesions accidentally during laparoscopic surgery.