Clinical Experiences of Fitz-Hugh-Curtis Syndrome

Young Chan Ham; Kang Lyool Lee; Dong Gue Shin; Seong Ku Kang; Sang Soo Park; Jin Yoon; Hyuk Jung Kim; Il Myung Kim

doi:10.4174/jkss.2009.76.1.36

Journal List > J Korean Surg Soc > v.76(1) > 1010968

Go to TopGo to Top Go to BottomGo to Bottom

TOOLS

Ham, Lee, Shin, Kang, Park, Yoon, Kim, and Kim: Clinical Experiences of Fitz-Hugh-Curtis Syndrome

Original Article

Journal of the Korean Surgical Society

Journal of the Korean Surgical Society 2009; 76(1): 36-42.

Published online: 31 January 2009

DOI: https://doi.org/10.4174/jkss.2009.76.1.36

Clinical Experiences of Fitz-Hugh-Curtis Syndrome

Young Chan Ham, M.D., Kang Lyool Lee, M.D., Dong Gue Shin, M.D., Seong Ku Kang, M.D., Sang Soo Park, M.D., Jin Yoon, M.D., Hyuk Jung Kim, M.D.¹, Il Myung Kim, M.D.

Department of Surgery, Seoul Medical Center, Seoul, Korea.

¹Department of Radiology, Seoul Medical Center, Seoul, Korea.

shinedk@seoulmc.or.kr

Received 8 July 2008 Accepted 20 August 2008

Abstract

Purpose

Fitz-Hugh-Curtis (FHC) syndrome has been described as perihepatitis associated with pelvic inflammatory disease during surgery. Recently, on computerized tomography a linear enhancement of the liver capsule was detected in a patient with FHC syndrome. We studied to evaluate the clinical course of the disease.

Methods

Sixteen patients diagnosed with FHC syndrome from CT findings were retrospectively studied from April, 2006 to June, 2008.

Results

The mean age of the patients was 25.9 (19~35) years and mean duration of abdominal pain was 3.9 (1~14) days. The most common complaint was right upper quadrant area pain (11 cases, 68.8%). 12 patients showed leukocytosis and all the patients had elevated serum C-reative protein levels. All the patients had normal liver function. Among the 9 patients which had polymerase chain reaction test for sexually transmitted disease (Chlamydia trachomatis, Ureaplasma urealyticum, Neisseria gonorrheae, Mycoplasma hominis), all showed more than one positive results (Chlamydia trachomatis 6 cases, Ureaplasma urealyticum 6 cases, Mycoplasma hominis 2 cases). On simple abdomen X-ray, 7 cases (43.8%) showed paralytic ileus. 14 cases received only antibiotic treatment, but 1 case had to take operation (laparoscopic-assisted adhesiolysis) due to constant abdominal pain and prolonged ileus.

Conclusion

It is important to rule out FHC syndrome by using CT findings, especially young women with right upper abdominal pain and PID. Usually, FHC syndrome can be treated easily with proper antibiotics.

Keywords: Fitz-Hugh-Curtis syndrome, Computed tomography, Perihepatitis, Pelvic inflammatory disease

Figures and Tables

Fig. 1

Abdominopelvic CT arterial phase. Linear subcapsular enhancement at the anterior surface of the liver (arrow).

Fig. 2

Sonographic finding of pelvic fluid collection.

Fig. 3

Operative finding of hepatic capsular inflammation with adhesion of capsule to peritoneum.

Fig. 4

Operative finding of pelvic inflammation with adhesion of uterus to ileum.

Table 1

Clinical characteristics of patients with FHC syndrome

^*Values are given as mean±SD; ^†Values are given as mean±SD (except 2 unchecked patients); ^‡Values are given as mean±SD (except 4 patients of follow-up loss).

Table 2

Abdominal pain & Physical examination of 16 patients with Fitz-Hugh-Curtis syndrome

^*Pt = patient number; ^†Td = tenderness; ^‡Rt. = right; ^§Lt. = left; ^∥CMT = cervical motion tenderness; ^¶RUQ = right upper quadrant; ^**BLQ = both lower quadrant; ^††RLQ = right lower quadrant; ^‡‡unchecked due to patient refusal of pelvic examination; ^§§not checked by doctor.

Table 3

Other symptoms of Fitz-Hugh-Curtis syndrome except abdominal pain

Table 4

Blood test and culture

^*Pt. = patient number; ^†WBC = White blood cell count (/µl, 4,000~10,000); ^‡CRP = C reactive protein (mg/dl, 0.0~0.4); ^§T.bil = total bilirubin (mg/dl, 0~1.3); ^∥ALP = Alkaline phosphatase (U/L, 30~125); ^¶AST = Aspartate transaminase (U/L, 0~40); ^**ALT = Alanine transaminase (U/L, 0~40); ^††(-): not checked; ^‡‡unchecked: Cervix culture was not checked, but Candida albicans was detected from urine.

Table 5

PCR^* test for STD results and antibiotics used

^*PCR = Polymerase chain reaction for STD 4 species; ^†STD = Sexually transmitted disease; ^‡Pt. = patient number; ^§ChT = Chlamydia trachomatis; ^∥UU = Ureaplasma urealyticum; ^¶MH = Mycoplasma hominis; ^**NG = Neisseria gonorrhoeae; ^††C = Cephalosporin IV; ^‡‡A = aminoglycoside IV; ^§§M = Metronidazle IV; ^∥∥D = Doxycycline po; ^¶¶+ = po cephalosporin; ^***- = patient refusal of admission at diagnosis and transferred other hospital.

References

1. Peter NG, Clark LR, Jaeger JR. Fitz-Hugh-Curtis syndrome: a diagnosis to consider in women with right upper quadrant pain. Cleve Clin J Med. 2004. 71:233–239.

2. Fitz-Hugh T Jr. Acute gonococcic peritonitis of the right upper quadrant in women. JAMA. 1934. 102:2094–2096.

3. Curtis AH. A cause of adhesions in the right upper quadrant. JAMA. 1930. 94:1221–1222.

4. Muller-Schoop JW, Wang SP, Munzinger J, Schlapfer HU, Knoblauch M, Tammann RW. Chlamydia trachomatis as possible cause of peritonitis and perihepatitis in young women. Br Med J. 1978. 1:1022–1024.

5. Wang SP, Eschenbach DA, Holmes KK, Wager G, Grayston JT. Chlamydia trachomatis infection in Fitz-Hugh-Curtis syndrome. Am J Obstet Gynecol. 1980. 138:1034–1038.

6. Lopes-Zeno JA, Keith LG, Berger GS. The Fitz-Hugh-Curtis syndrome revisited: changing perspectives after half a century. J Reprod Med. 1985. 30:567–582.

7. Sharma JB, Roy KK, Gupta N, Jain SK, Malhotra N, Mittal S. High prevalence of Fitz-Hugh-Curtis syndrome in genital tuberculosis. Int J Gynecol Obstet. 2007. 99:62–63.

8. Nishie A, Yoshimiusu K, Irie H, Yoshitake T, Aibe H, Tajima T, et al. Fitz-Hugh-Curtis syndrome radiologic manifestation. J Comput Assist Tomogr. 2003. 27:786–791.

9. Oh JH, Cho YS, Choi YH, Lee HS. A diagnostic utility of Fitz-Hugh-Curtis syndrome by using contrast enhanced abdominopelvic computerized tomography. J Korean Soc Emerg Med. 2005. 16:410–415.

10. Jin SC, Sohn YD, Choi WI. Two cases of Fitz-Hugh-Curtis syndrome diagnosed by abdominopelvic computerized tomography. Keimyung Med J. 2006. 26:52–56.

11. Lee SC, Nah BG, Kim HS, Choi TH, Lee SH, Lee JY, et al. Two cases of Fitz-Hugh-Curtis syndrome in acute phase. Korean J Gastroenterol. 2005. 45:137–142.

12. Zeger W, Holt K. Gynecologic infections. Emerg Med Clin North Am. 2003. 21:631–648.

13. Tsubuku M, Hayashi S, Terahara A, Furukawa T, Ohmura G. Fitz-Hugh-Curtis syndrome: linear contrast enhancement of the surface of the liver on CT. J Comput Assist Tomogr. 2002. 26:456–458.

14. Kechagia N, Bersimis S, Chatzipanagiotou S. Incidence and antimicrobial susceptibilities of genital mycoplasmas in outpatient women with clinical vaginitis in Athens, Greece. J Antimicrob Chemother. 2008. 62:122–125.

15. McCormick M, DelCastillo J, Berk RS. An atypical presentation of the Fitz-Hugh-Curtis syndrome. J Emerg Med. 1990. 8:55–58.

TOOLS

Similar articles