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

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



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.


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


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.


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.

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.


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