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Fitz-Hugh-Curtis Syndrome

Updated : August 9, 2023





Background

Perihepatitis, also known as FHCS (Fitz-Hugh-Curtis syndrome), is a persistent symptom of PID (pelvic inflammatory illness). Without involving the hepatic parenchyma, it is described as an inflammatory response of the hepatic capsule with adhesion formation and upper right quadrant ache. Through direct inspection of adhesions that resemble violin strings during laparotomy or laparoscopy and through liver capsule biopsy & culture, a definitive diagnosis can be confirmed.

Stajano published the first illustration of the syndrome in a non-English article in 1920. In individuals with unusual gallbladder episodes, Curtis documented adhesions between the abdominal wall and anterior side of the liver that was discovered during laparotomies in 1930. Although no additional upper abdomen disease was discovered, he noted that the victims frequently displayed persistent gonococcal tube alterations.

Similar instances that manifested with upper right quadrant abdominal discomfort were described by Fitz-Hugh, Jr. in 1934. The anterior side and margin of the liver, as well as the nearby peritoneal layer of the diaphragm, were affected by uncommon, local peritonitis, as shown by laparotomy. Following drainage, smears of the fluid that had been drained revealed intracellular, biscuit-shaped, gram-negative diplococci. However, it is now known that the illness has been observed in both genders and is not just associated with gonococcal infestation.

Epidemiology

PID is a sexual activity female infection of the genital area that affects women between the ages of 15 and 30. Each year, there are 750,000 PID cases in the US. FHCS is a rare form of PID that affects about 4% of teenagers. Despite the fact that FHCS is linked to a wide variety of organisms, Chlamydia trachomatis is the most prevalent organism involved.

Anatomy

Pathophysiology

FHCS is a problem with PID, as was mentioned in the section on etiology. PID-related microorganisms are thought to propagate in any of 3 stages:

  • Through a process known as spontaneously ascending infections, germs from the cervix and vagina spread to the endometrium, Fallopian tubes, and peritoneum. Endometritis, tubal-ovarian abscess, salpingitis, perihepatitis, and pelvic peritonitis are among the complications.
  • Additionally, pathogens can spread through lymphatic pathways, as in the case of a parametrium infection brought on by an intrauterine device.
  • Finally, like with tuberculosis, hematogenous transmission is also a possibility.

 

Etiology

PID can develop Fitz-Hugh-Curtis syndrome as a side effect. There are three potential ways that PID-related microbes can spread:

  • Through a process known as spontaneously ascending infections, germs from the cervix and vagina spread to the endometrium, Fallopian tubes, and peritoneum. Endometritis, tubal-ovarian abscess, salpingitis, perihepatitis, and pelvic peritonitis are among the complications.
  • Lymphatic expansion, such as an intrauterine device-related infestation of the parametrium.
  • Hematogenous transmission, like that of tuberculosis

Genetics

Prognostic Factors

The prognosis of Fitz-Hugh-Curtis syndrome is poorly understood because it typically responds to antibiotics extremely effectively.

Only one patient in each treatment group experienced treatment failure in a study comparing triple therapy (gentamicin, metronidazole, and penicillin) to augmentin for non-chlamydial salpingitis.

Clinical History

Physical Examination

Age group

Associated comorbidity

Associated activity

Acuity of presentation

Differential Diagnoses

Laboratory Studies

Imaging Studies

Procedures

Histologic Findings

Staging

Treatment Paradigm

by Stage

by Modality

Chemotherapy

Radiation Therapy

Surgical Interventions

Hormone Therapy

Immunotherapy

Hyperthermia

Photodynamic Therapy

Stem Cell Transplant

Targeted Therapy

Palliative Care

Medication

Media Gallary

References

https://www.ncbi.nlm.nih.gov/books/NBK499950/

Fitz-Hugh-Curtis Syndrome

Updated : August 9, 2023




Perihepatitis, also known as FHCS (Fitz-Hugh-Curtis syndrome), is a persistent symptom of PID (pelvic inflammatory illness). Without involving the hepatic parenchyma, it is described as an inflammatory response of the hepatic capsule with adhesion formation and upper right quadrant ache. Through direct inspection of adhesions that resemble violin strings during laparotomy or laparoscopy and through liver capsule biopsy & culture, a definitive diagnosis can be confirmed.

Stajano published the first illustration of the syndrome in a non-English article in 1920. In individuals with unusual gallbladder episodes, Curtis documented adhesions between the abdominal wall and anterior side of the liver that was discovered during laparotomies in 1930. Although no additional upper abdomen disease was discovered, he noted that the victims frequently displayed persistent gonococcal tube alterations.

Similar instances that manifested with upper right quadrant abdominal discomfort were described by Fitz-Hugh, Jr. in 1934. The anterior side and margin of the liver, as well as the nearby peritoneal layer of the diaphragm, were affected by uncommon, local peritonitis, as shown by laparotomy. Following drainage, smears of the fluid that had been drained revealed intracellular, biscuit-shaped, gram-negative diplococci. However, it is now known that the illness has been observed in both genders and is not just associated with gonococcal infestation.

PID is a sexual activity female infection of the genital area that affects women between the ages of 15 and 30. Each year, there are 750,000 PID cases in the US. FHCS is a rare form of PID that affects about 4% of teenagers. Despite the fact that FHCS is linked to a wide variety of organisms, Chlamydia trachomatis is the most prevalent organism involved.

FHCS is a problem with PID, as was mentioned in the section on etiology. PID-related microorganisms are thought to propagate in any of 3 stages:

  • Through a process known as spontaneously ascending infections, germs from the cervix and vagina spread to the endometrium, Fallopian tubes, and peritoneum. Endometritis, tubal-ovarian abscess, salpingitis, perihepatitis, and pelvic peritonitis are among the complications.
  • Additionally, pathogens can spread through lymphatic pathways, as in the case of a parametrium infection brought on by an intrauterine device.
  • Finally, like with tuberculosis, hematogenous transmission is also a possibility.

 

PID can develop Fitz-Hugh-Curtis syndrome as a side effect. There are three potential ways that PID-related microbes can spread:

  • Through a process known as spontaneously ascending infections, germs from the cervix and vagina spread to the endometrium, Fallopian tubes, and peritoneum. Endometritis, tubal-ovarian abscess, salpingitis, perihepatitis, and pelvic peritonitis are among the complications.
  • Lymphatic expansion, such as an intrauterine device-related infestation of the parametrium.
  • Hematogenous transmission, like that of tuberculosis

The prognosis of Fitz-Hugh-Curtis syndrome is poorly understood because it typically responds to antibiotics extremely effectively.

Only one patient in each treatment group experienced treatment failure in a study comparing triple therapy (gentamicin, metronidazole, and penicillin) to augmentin for non-chlamydial salpingitis.

https://www.ncbi.nlm.nih.gov/books/NBK499950/