Fitz-Hugh-Curtis Syndrome, Multidisciplinary Pathology, Often Underrated

Introduction: Fitz-Hugh-Curtis Syndrome, a rare complication of pelvic inflammatory disease, consists of Glisson's capsule inflammation that causes a perihepatic adhesional syndrome. It affects women at childbearing age who have Pelvic Inflammatory Disease, mostly determined by Chlamydia trachomatis infection. Symptoms include pain in the right upper quadrant, augmented by cough, deep breathing and other maneuvers that increase the intraabdominal pressure. Material and Method: We conducted a retrospective study between January and December 2015, at "Nicolae Malaxa" Clinical Hospital Bucharest, based on the patients' charts and operative protocols from General Surgery and Obstetrics and Gynecology departments. The Fitz-Hugh-Curtis Syndrome diagnosis was established based on intraoperative discovery of adherence syndrome. Results: Nine patients aged 23 to 46 years old, were admitted for pain in the upper right quadrant, with or without pain in the lower abdomen (7 patients) or pain in the pelvic region (2 patients). The main diagnosis at admission was cholelithiasis for 5 patients, acute appendicitis in 2 cases and PID in 2 cases. We performed exploratory laparoscopy in all cases and we identified perihepatic adhesions. Laparoscopic adhesion lysis was performed together with the surgical cure of associated pathology in 7 cases and antibiotic treatment in all cases. We tested all the patients serologically for C. Trachomatis and 7 out of 9 patients had Ig G antibodies against C. Trachomatis. Conclusions: The Fitz-Hugh-Curtis Syndrome must be taken into consideration in all reproductive age female patients that present with pain in the upper right abdomen, alone or together with pain in the lower abdomen. In many cases the symptoms can mimic hepatobiliary tract pathology. Treatment consists of antibiotic therapy and laparoscopic adhesion lysis in complicated cases.