DR MOHAMMED IRFAN SHEIKH almost 4 years ago

Fitz-Hugh–Curtis Syndrome

A 62-year-old woman presented to the surgical outpatient clinic with a 3-month history of intermittent abdominal pain in the right upper quadrant. Approximately 4 months before presentation, she had received a diagnosis of and been treated for pelvic inflammatory disease. The signs and symptoms at that time, which included severe lower abdominal pain and purulent vaginal discharge, had resolved with the completion of antibiotic treatment. The physical examination at the current visit was notable for a soft abdomen and moderate tenderness of the right upper quadrant. Laboratory studies, including a complete blood count and C-reactive protein and liver-function tests, were normal. An ultrasound examination of the abdomen revealed cholelithiasis. A plan for cholecystectomy was made for suspected biliary colic. On laparoscopy, extensive, dense adhesions between the anterosuperior hepatic surface and the abdominal wall were seen (Panels A and B [anterior and superior surfaces of the liver, respectively]). Sometimes referred to as “violin string–like adhesions,” this finding is characteristic of the Fitz-Hugh–Curtis syndrome, a condition in which perihepatitis develops in association with pelvic inflammatory disease. Perihepatic lysis of adhesions and cholecystectomy were performed. At follow-up 5 months after surgery, the patient was well and had no abdominal pain.